Presentation (CTI)

OBJECTIVES: Indirect costs evaluation is important for cost-effectiveness analysis considering the societal perspective. Heart failure (HF) is a chronic condition with varying degrees of severity directly impairing functional capacity. Our objective was to assess characteristics and economic burden of retirement beneficiaries with HF in the Brazilian National Institute of Social Security (INSS).
METHODS: We included retirement benefits granted from INSS (2014-2023) for ICDs codes related to HF cases (CID10 I50, I50.0, I50.1, I50.9) in adults (≥18 years-old). Benefit duration (months and years) was estimated considering the average life expectancy, according to sex and age, adjusting Brazilian life tables for the excess mortality attributable to HF and limiting to the observed period and expected retirement age. Premature retirement was calculated considering the age at benefit concession and expected retirement age. Expenditures (BRL) were calculated considering the duration and number of minimum wages granted, adjusting for inflation up to December 2023.
RESULTS: Over a 10-year period, a total of 126,877 benefits were granted for Brazilian HF adults, of which 25,340 (20%) were retirements. Most beneficiaries were men (78.9%), with mean age 53.9±7.2 years. The region with highest number of retirements was Southeast (44.2%), followed by Northeast (29%) and South (16.3%). Median retirement duration was 44.4 months (~4 years, interquartile range - IQR 18.9-63.6), with total productivity loss of 92,996 work-years, and mean premature retirement of 10.1±7.1 years (median 8.6, IQR 4.72-13.99). The median total retirement wages granted by beneficiary was R$72,745 (IQR R$29,523-118,639), with total retirement expenditure of R$2,256,493,130 (~2 billion).
CONCLUSIONS: In the last 10 years, Brazilian social security system incurred a burden exceeding 2 billion (BRL) solely attributable to retirements by HF. The negative impact of HF-related retirements in Brazil strains the social security system and hampers economic productivity. Distribution of benefits in the Brazilian regions followed the population distribution.