OBJECTIVES : To quantify the overall per-patient and aggregate insurer and out-of-pocket healthcare expenditures for VHD stratified by age cohort, aortic valve disease (AVD), mitral valve disease (MVD), and disease symptomology.

METHODS : Based on 1996–2015 data from the Medical Expenditure Panel Survey (MEPS), a large, nationally representative US database, multivariate analyses were performed to assess the relationship between AVD and MVD and direct annual healthcare costs to insurers and patients, at individual and US-aggregate levels. All adults aged 18 years and over with International Classification of Diseases (ninth revision) diagnosis code(s) for AVD or MVD were included. The 3 age cohorts (18-64 years-old, ≥65 years, and ≥75 years) were further stratified by disease status: symptomatic AVD, asymptomatic AVD, symptomatic MVD, and asymptomatic MVD. These classifications were determined with clinical assistance given the data available in MEPS.

RESULTS : The MEPS database included 1463 individuals with VHD. This total included 28 individuals aged 18-64 years and 54 aged ≥65 years with symptomatic AVD. There were 61 individuals aged 18-64 years and 65 aged ≥65 years with asymptomatic AVD. Individuals with symptomatic MVD included 244 aged 18-64 years and 163 aged ≥65 years. Individuals with asymptomatic MVD included 620 aged 18-64 years and 228 aged ≥65 years. The overall incremental direct expenditures were $56.62 billion when aggregated to the United States population. The incremental cost for patients aged ≥75 years was $26.48 (47%) billion. Individuals aged ≥75 years with symptomatic AVD had the largest incremental effect on annual, per-person healthcare expenditure (insurer + out of pocket) of $30,949.

CONCLUSIONS : The annualized incremental costs of VHD were substantial for all cohorts examined, and greatest for the cohort of individuals aged ≥75 with AVD. This reflects the relatively high prevalence associated with this group.