Socioeconomic Burden of Ischemic Heart Diseases in the Japanese Healthcare System – A System Dynamics Simulation for Policy Decision-Making

OBJECTIVES: Ischemic heart diseases (IHD), including myocardial infarction (MI) often lead to recurrent cardiovascular events and heart failure (HF) and impose a significant societal financial burden. This study aimed to understand the socio-economic burden of IHD leading to HF on the future Japanese healthcare system, and to estimate the impacts of health interventions using system dynamics (SD) simulation.

METHODS: An SD model was developed to simulate the progression of MI to HF among the Japanese population aged ≥40 years during 2010 to 2070. Costs were calculated from the Japanese healthcare system and societal perspectives.

RESULTS: The number of patients with MI will increase until 2054, while for ischemic HF the increase is expected until 2066. Among health interventions considered in the population as of 2040, physician's consultation including monitoring and medication treatments for the high-risk MI population will result in the largest reduction in direct costs for acute and chronic MI (by ¥220.2 billion) and HF (by ¥20.1 billion) with the cost for intervention up to ¥346.7 billion. Introduction of lipid management pathways to patients with acute and chronic MI was considered the least costly option (cost for introduction of intervention by ¥16.7 billion) that reduces the direct costs for acute MI (by ¥39.4 billion) and HF (by ¥8.4 billion), while increasing the management cost for chronic MI (by ¥32.6 billion).

CONCLUSIONS: According to the latest epidemiological and cost evidence, the populations with MI and HF and the corresponding cost burdens in Japan will increase until the early 2050’s and late 2060’s, respectively. Primary prevention involving physicians will result in the largest reductions in MI and HF costs among the considered health interventions, while secondary prevention with lipid management pathways for patients with MI will be the least costly option by reducing the costs for subsequent MI hospitalizations and HF.