Risk for cardiovascular disease in the elderly and associated Medicare costs: the Framingham Study

Studies of young, employed populations have established an association between risk factors for cardiovascular disease and health care costs, but an association has never been demonstrated in an elderly population. For the surviving elderly cohort (63 to 93 years of age) of the Framingham Heart Study (n = 1,053), we estimated a model regressing Medicare reimbursements per beneficiary over two years (1984 and 1985) on the two-year probability of cardiovascular disease at Exam 17 (1982 or 1983), controlling for other risk factors and prior health services use. Using the coefficient for the two-year probability for cardiovascular disease, we estimated Medicare cost ratios and dollar values associated with elevated compared with nonelevated risk for 12 risk profiles for cardiovascular disease. The average level of risk for cardiovascular disease in the elderly is associated with Medicare claims costs that are 19% higher (95% confidence interval [CI] = 10%, 29%) than those for persons with no elevated risk, equivalent to an average of $371 per elderly beneficiary or $9.3 billion per year in Medicare expenditures. Smoking is associated with 16% (95% CI = 8%, 24%) higher Medicare costs than nonsmokers' costs. Systolic blood pressure of 160 mm Hg is associated with 11% (95% CI = 6%, 16%) higher Medicare costs, compared with a systolic blood pressure of 140 mm Hg. A total blood cholesterol level of 260 mg/dL is associated with 6% (95% CI = 3%, 9%) higher Medicare costs, compared with a total blood cholesterol of 180 mg/dL. Additional studies are needed to help calculate the cost-effectiveness of risk reduction for the elderly.