Costs Related to Atherosclerotic Cardiovascular Disease in Brazil: Analysis From the Perspective of the Society

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High-risk individuals face costs from premature death and productivity loss due to sick leave and retirement. In Brazil, the economic burden of hypertension, heart failure, myocardial infarction, and atrial fibrillation was estimated at 56 million Brazilian reais (BRL) in 2015, including both direct and indirect costs. Understanding the burden of a disease is essential for proposing effective public policies. Using DATASUS data, this study estimated the costs of atherosclerotic cardiovascular disease (ASCVD) in Brazil from a societal perspective. Methods This analysis used data from 2008 to 2023, focusing on three types of ASCVD: ischemic heart disease (IHD), ischemic stroke (IS), and peripheral arterial disease (PAD). The DATASUS hospital database was used to quantify direct costs in the public system and collect patient demographic details. Estimates for direct costs on the private system were based on the TISS database, while social security benefits were sourced from the Brazilian Ministry of Social Security. Results ASCVD lead to over 600,000 hospitalizations annually in Brazil, predominantly in the public system (82%). Coronary Artery Disease (CHD) imposes the highest costs, while PAD incurs the lowest. Indirect costs related to death represent nearly BRL 4 billion annually, similar magnitude to all direct medical costs. The indirect costs from absenteeism are approximately BRL 181 million per year, significantly lower than the magnitude of direct medical and death-related indirect costs. There is a trend that shows that absenteeism-related costs are decreasing, possibly due to the increase in mortality rates in patients with IHD. In Brazil, social security benefits for cardiovascular diseases total about BRL 100 million annually, with IHD being the most significant. The annual economic burden of these diseases is around BRL 10 billion, expected to reach BRL 60 billion in the next five years. Conclusions In conclusion, ASCVD present a significant economic burden in Brazil, primarily through direct medical costs in the public system. Indirect costs from premature deaths and productivity losses are also substantial. The high mortality rate among economically active individuals worsens these impacts. To reduce costs, focusing on targeted prevention, early diagnosis, and effective treatment is essential. Cardiovascular Diseases Costs and Cost Analysis Ischemic Heart Disease Ischemic Stroke Peripheral Arterial Disease Figures Figure 1 INTRODUCTION Non-communicable chronic diseases (NCDs) - mainly represented by cardiovascular disease (CVD), cancer, and chronic respiratory diseases - causes approximately 38 million deaths annually, being the leading cause of death worldwide.[ 1 ] The Brazilian Society of Cardiology (SBC) estimates that almost 400,000 Brazilian citizens die each year from heart and circulatory diseases. Among these pathologies, the vast majority (76%) is represented by atherosclerotic cardiovascular disease (ASCVD).[ 2 ] In Brazil, the most common form of ASCVD is acute myocardial infarction and heart failure.[ 3 ] ASCVD affect the carotid, coronary, aorta, and peripheral arteries.[ 4 ] The main symptoms are chest pain, edema, limb pain, palpitation, and syncope. There has been a high prevalence of risk factors for these diseases in the last two decades, such as obesity, sedentary lifestyle, smoking. and poor diet.[ 3 ] CVDs are a public health concern that impacts the population’s health and economy.[ 5 ] Globally, an increase in the number of deaths due to CVD from 12.1 million (95% CI: 11.4 to 12.6 million) in 1990 to 18.6 million (95% CI: 17.1 to 19.7 million) in 2019 is observed.[ 5 ] In addition to premature deaths, individuals at high cardiovascular risk experience more lost working hours and higher indirect costs compared to those without cardiovascular events.[ 6 ] Consistently, significant increases are in the global trends for disability-adjusted life years (DALYs) and years of life lost. Years lived with disability doubled from 17.7 million (95% CI: 12.9 to 22.5 million) to 34.4 million (95% CI: 24.9 to 43.6 million) between 1990 and 2019.[ 2 ] Considering the specific context of South America, an important burden due to CVD is also observed. Marinho (2023) reported in an editorial that considering 2019 alone, over 750,000 deaths were attributed to CVD. This accounts for approximately 2,040,973 years of potential life lost (YPLL). Regarding productivity loss, the author described that this outcome imposed an economic impact equivalent to 0.11% of the region's gross domestic product (GDP), translating to an estimated cost of nearly 4 billion USD in purchasing power parity.[ 5 ] In Brazil, the economic burden of four heart conditions (hypertension, heart failure, myocardial infarction, and atrial fibrillation) was estimated at 56 million Brazilian real (BRL) in 2015, considering both direct and indirect costs.[ 7 ] Additionally, the cost of hospitalizations for cardiovascular diseases is considered the highest among the causes of hospital admissions in Brazil.[ 7 ] A continuous understanding on the burden of a given disease is necessary to propose public policies related to disease management. Based on data from DATASUS, this study estimated the costs associated with ASCVD in Brazil, considering the perspective of the society. METHODS Data sources This analysis used data from 2008 until 2023, however, the period varied depending on the dataset used. This study focuses on 3 main groups of atherosclerotic cardiovascular diseases, which were extracted from the databases considering the following ICD-10 codes as the main diagnosis: ischemic heart disease (IHD; I20, I21, I22, I24 e I25); ischemic stroke (IS; I64); and peripheral arterial disease (PAD; I73). The DATASUS hospital database was used to quantify direct costs in the Brazilian Unified Health System (SUS). This public, anonymized database used for reimbursement purposes aggregates data on all hospital procedures performed within SUS from 2008 to now. In addition to information such as the procedures performed, the main diagnosis (using the ICD-10 code), and the patient's demographic details, the database also includes information about the healthcare provider and the costs related to the treatment. Documentation with more information on the database can be accessed at the Brazilian Ministry of Health website.[ 8 ] The estimations of direct cost for the Brazilian private health system (ANS) was based on the TISS database [ 9 ], a standard for information exchange in the private healthcare system. The database includes information like the quantity and fees paid by the health operators to the healthcare providers for the performed procedures. Other information, such as patient demographics and diagnostics, is also provided. Data is available from 2015 to 2022. Social security benefits paid by the Brazilian government were extracted by ICD-10 and a year from Infologo [ 10 ], a public system provided by the Brazilian Ministry of Social Security, which aggregates all benefits paid by the government to the Brazilian population. Indirect costs related to mortality were based on the 2022 projected life expectancy from the Brazilian Mortality Tables provided by the Brazilian Institute of Geography and Statistics (IBGE).[ 11 ] Deaths caused by cardiovascular disease were evaluated by the patient's age, considering data from the Mortality Information System (SIM) death certificates. This centralized database has gathered information from all Brazilian territories since 1975. Hospital admissions The number of hospital admissions was calculated based on the databases above, considering the relevant ICD-10 codes, and quantified annually from 2010 to 2023 for SUS and 2018 to 2022 for ANS. The difference in the periods evaluated is due to 1) the availability of a longer follow-up period for SUS and 2) a more pronounced bias from the pandemic period (2020 and 2021) in the SUS data rather than on ANS. The number of hospital admissions was segmented by type of ASCVD (IHD, IS, or PAD). Direct costs The costs were quantified as the total cost of ASCVD by year and the average cost per hospitalization. They were also segmented by type of ASCVD (IHD, IS, or PAD). Indirect costs Indirect costs were divided into two categories: productivity loss due to death (projected productivity for an individual of working age who can no longer produce due to premature death) and productivity loss related to temporary work absence due to illness (absenteeism). The productivity loss due to death considered working age individuals between 14 and 64 years old, as defined by IBGE in its Continuous National Household Sample Survey (PNAD). [ 12 ] The cost of productivity loss due to death was estimated by calculating the productive years lost due to premature death (defined as 64 minus the patient's age at death), multiplied by the average annual salary in Brazil in the 2nd quarter of 2024 (BRL 37,356.00), using a present value discount rate of 5% per year.[ 12 ] This same methodology was used in other studies assessing Brazil's cardiovascular disease burden.[ 13 ] Productivity loss related to absenteeism was calculated based on the number of hospitalizations per year for the mentioned ICD-10 codes, both in the public (SUS) and private (ANS) healthcare systems, multiplied by the average monthly wage in Brazil (BRL 3,113.00) in the second half of 2024, and by an average work absence period of 3.4 months.[ 12 , 13 ] Social security benefits To estimate the impact of temporary leave (sick leave) and permanent leave (retirements), information available on the Social Security website (Infologo) was used. An analysis was conducted on the number of benefits granted for ASCVD defined by the predefined ICD-10 codes. The aggregated benefits paid by ASCVD disease groups were analyzed by year, considering the period between 2017 and 2022, the latest year where data was available. Projections Based on the historical data available from the various data sources used in this analysis, a projection of the costs related to ASCVD for the next five years (2025–2029) was made. Costs were forecasted based on historical data using the ETS (Error, Trend, and Seasonality) method, an exponential smoothing methodology, and Holt’s model, which can be helpful when a clear trend can be seen in the data.[ 14 ] Forecasting was done using R, version 4.4.1, using the package forecast. [ 15 , 16 ] RESULTS Direct medical costs ASCVD is responsible for more than 600,000 hospitalizations per year in Brazil (Table 1 ), most of them in SUS (82%), which is compatible with the private system coverage (approximately 25% of the Brazilian population is covered by a private healthcare plan). Nevertheless, ANS presents costs approximately 30% higher than those seen in SUS. IHD shows the highest costs, while PAD is the lowest (Table 2 ). Table 1 Hospital admissions by ASCVD. Hospital admissions by ASCVD 2025 2026 2027 2028 2029 SUS 514.626 523.517 532.408 541.300 550.191 Ischemic heart disease 300.077 303.011 305.945 308.879 311.814 Ischemic stroke 195.162 200.259 205.355 210.451 215.547 Peripheral arterial disease 19.386 20.247 21.108 21.969 22.831 ANS 110.843 114.255 117.668 121.081 124.493 Ischemic heart disease 76.797 79.526 82.254 84.983 87.712 Ischemic stroke 30.150 30.496 30.842 31.188 31.534 Peripheral arterial disease 3.895 4.233 4.571 4.909 5.247 Total (SUS + ANS) 625.468 637.772 650.076 662.380 674.684 Table 2 Direct medical costs by ASCVD (BRL). Hospital admissions by ASCVD 2025 2026 2027 2028 2029 SUS 2.116.507.233 2.215.411.514 2.314.315.795 2.413.220.077 2.512.124.358 IS 351.333.388 365.159.385 378.985.382 392.811.380 406.637.377 PAD 47.828.818 49.186.810 50.544.802 51.902.793 53.260.785 IHD 1.717.345.027 1 801.065.319 1.884.785.611 1.968.505.904 2.052.226.196 ANS 2.803.244.273 2.959.793.909 3.116.343.545 3.272.893.181 3.429.442.817 IS 956.162.550 1.002.213.899 1.048.265.247 1.094.316.595 1.140.367.943 PAD 95.928.938 104.634.545 113.340.152 122.045.759 130.751.366 IHD 1.751.152.785 1.852.945.465 1.954.738.146 2.056.530.827 2.158.323.508 Total (SUS + ANS) 4.919.751.506 5.175.205.423 5.430.659.340 5.686.113.258 5.941.567.175 BRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease. Death-related indirect costs Figure 1 shows the distribution of death from ASCVD in 2023 by age group. Approximately 30% occurred in patients in the economic active range (from 14 to 64 years old). Indirect costs related to death represent almost BRL 4 billion per year (Table 3 ), the same magnitude as all direct medical costs. Table 3 Indirect costs related to death (BRL). 2025 2026 2027 2028 2029 IS 591.029.604 593.744.234 596.335.022 598.798.730 601.134.239 PAD 40.583.141 42.277.607 43.894.771 45.432.611 46.890.431 IHD 3.641.542.369 3.663.409.113 3.684.278.294 3.704.123.824 3.722.936.700 Total 4,273,155,115 4.299.430.954 4.324.508.087 4.348.355.164 4.370.961.370 BRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease. Absenteeism-related indirect costs Considering the average wage in Brazil (BRL 3,113.00), the number of hospital admissions, and the average recovery time of 3.4 months, absenteeism-related indirect costs represent approximately BRL 181 million per year (Table 4 ), which can be considered a lower cost besides the magnitude of direct medical costs and indirect costs related to death. An interesting trend can be noted that absenteeism-related costs are decreasing with time, which may be linked to an increase in mortality observed in patients with IHD. Table 4 Indirect costs related to absenteeism (BRL). 2025 2026 2027 2028 2029 IS 143.645.826 143.664.697 143.697.902 143.745.805 143.808.555 PAD 13.885.558 13.940.668 14.006.789 14.084.210 14.173.030 IHD 27.253.713 25.361.385 23.575.419 21.898.582 20.331.859 Total 184.785.097 182.966.751 181.280.110 179.728.597 178.313.444 BRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease. Social Security-related costs Social security benefits paid to patients with ASCVD represent approximately BRL 100 million annually (Table 5 ), with IHD being the most relevant disease regarding paid benefits. Table 5 Social security benefits paid (BRL). 2025 2026 2027 2028 2029 IHD 59.584.840 61.277.042 62.969.244 64.661.447 66.353.707 IS 28.098.214 29.337.188 30.576.162 31.815.161 33.054.135 PAD 2.298.787 2.374.377 2.449.967 2.525.560 2.601.150 Total 89.981.840 92.988.607 95.995.374 99.002.168 102.008.992 BRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease. Economic burden of ASCVD in Brazil The economic burden of ASCVD in Brazil is approximately BRL 10 billion annually, most related to indirect medical costs. The country is expected to spend around BRL 60 billion on the disease in the next five years (Table 6 ). Table 6 Economic burden of ASCVD in Brazil (BRL). Category 2025 2026 2027 2028 2029 Total Direct medical costs - SUS 2.116.507.233 2.215.411.514 2.314.315.795 2.413.220.077 2.512.124.358 13.589.181.928 IS 351.333.388 365.159.385 378.985.382 392.811.380 406.637.377 2.232.434.303 PAD 47.828.818 49.186.810 50.544.802 51.902.793 53.260.785 299.194.834 IHD 1.717.345.027 1.801.065.319 1.884.785.611 1.968.505.904 2.052.226.196 11.057.552.791 Direct medical costs - ANS 2.803.244.273 2.959.793.909 3.116.343.545 3.272.893.181 3.429.442.817 18.228.412.362 IS 956.162.550 1.002.213.899 1.04.8265.247 1.094.316.595 1.140.367.943 6.151.437.436 PAD 95.928.938 104.634.545 113.340.152 122.045.759 130.751.366 653.924.091 IHD 1.751.152.785 1.852.945.465 1.954.738.146 2.056.530.827 2.158.323.508 11.423.050.835 Indirect costs 4.547.922.052 4.575.386.312 4.601.783.571 4.627.085.929 4.651.283.806 27.571.064.629 Death 4.273.155.115 4.299.430.954 4.324.508.087 4.348.355.164 4.370.961.370 25.862.122.669 Absenteeism 184.785.097 182.966.751 181.280.110 179.728.597 178.313.444 1.144.800.225 Social security 89.981.840 92.988.607 95.995.374 99.002.168 102.008.992 564.141.734 Total 9.467.673.558 9.750.591.735 10.032.442.911 10.313.199.187 10.592.850.981 59.388.658.919 BRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease. DISCUSSION Atherosclerotic cardiovascular diseases (IHD, IS, and PAD) represent a significant economic burden in Brazil, totaling a cost of approximately BRL 10 billion per year (approximately 2 billion dollars, considering an exchange rate of USD 1 = BRL 5.08). Indirect medical costs, including mortality-related and absenteeism-related costs primarily drive the costs. Direct medical costs are substantial and growing, particularly within SUS, which covers much of the Brazilian population. SUS accounts for most hospital admissions related to atherosclerotic diseases (82%). The direct costs are higher in ANS than in SUS, with IHD incurring the highest costs and PAD the lowest The breakdown by disease type shows a marked dominance of IHD in both direct medical costs and hospital admissions. Stevens et al. (2018) conducted a similar study, with the aim to assess the economic burden of heart conditions in Brazil, under the perspective of the society. Costs associated with the management of hypertension, heart failure, myocardial infarction, and atrial fibrillation were calculated. Total cost estimated for 2015 was BRL 56 million (approximately 11 million, considering an exchange rate of BRL 1 = BRL 5.08) and health system costs represented 63% of this amount. Myocardial infarction was responsible for the highest amount.[ 7 ] Despite different conditions have been assessed, IHD, IS and PAD in our analysis and hypertension, heart failure, myocardial infarction, and atrial fibrillation in the former study, it is possible to highlight an increase in the costs. Gheorghe et al. (2018) systematically reviewed the literature to understand the economic burden of the cardiovascular diseases and hypertension in low and middle income countries. Stroke and coronary heart disease imposed the higher direct costs, when compared to hypertension, heart failure and generic cardiovascular diseases. An important variation on estimated cost is observed. For example, the ratio of annual cost of care to country-specific total health expenditure per capita ranges from 4.48 to 472.48 international dollars.[ 17 ] Such results highlights that there is still a gap on the knowledge on the burden of cardiovascular diseases in these countries and further analysis are needed to suggest initiatives to decrease such impact. In the present analysis, an increment on costs related to cardiovascular diseases management was shown in the 2025–2029 period. An analysis in the United States showed that, for cardiovascular conditions, annual healthcare costs are projected to nearly quadruple, from 393 billion USD to 1,490 billion USD, between 2020 and 2050.[ 18 ] Disregarding the large difference between the values, a large increase in the cost of cardiovascular diseases is also expected in the United States, as this study showed regarding these costs in Brazil. In the United States, stroke is projected to account for the largest absolute cost increase, unlike in Brazil, where IHD was the most significant contributor. Further studies are needed to understand reasons for the increase of burden in each disease. Furthermore, social security benefits paid to individuals with atherosclerotic diseases are around BRL 100 million annually. This represents another dimension of the indirect costs to the Brazilian economy. In 2022, the total amount paid by the Brazilian social security system was BRL 3,728,378,420.24. Diseases of the circulatory system represented 6% of this total, which corresponds to BRL 222,170,309.50. Other causes such as neoplasms and diseases of the respiratory system represented 7% (BRL 262,703,687.06) and 0.8% (BRL 29,163,148.34), respectively.[ 10 ] Azambuja et al. (2018) reported that severe cardiovascular diseases imposed a financial burden of BRL 2.57 billion on Brazilian social security, accounting for 0.16% of the country’s gross domestic product.[ 19 ] In the European Union (EU), cardiovascular diseases resulted in an estimated cost of €155 billion to the EU's health and social care systems, representing 11% of the total healthcare expenditure in 2021.[ 20 ] The implications of high mortality rates among the economically active age group due to atherosclerotic diseases have a broader socioeconomic impact, including the loss of a productive workforce. Death-related indirect costs are significant, mainly because approximately 30% of deaths from atherosclerotic diseases occur in the economically active age group (14–64 years old), contributing to nearly BRL 4 billion annually in indirect costs. This is comparable to the direct medical costs. Moreover, absenteeism-related costs are much lower than death-related costs, which are still notable (about BRL 180 million). This cost aligns with a study conducted in South America, which estimated that the annual productivity loss due to CVDs was around 3.7 billion USD.[ 6 ] This research highlighted Brazil and Argentina as the countries most impacted by productivity reductions, underscoring the detrimental effects of CVDs on economic growth.[ 6 ] However, few studies have examined the productivity losses associated with CVDs in South America. On the other hand, the USA's productivity losses due to CVDs are projected to rise from 234 billion USD to 361 billion USD/year between 2020 and 2050. Despite the significant amount, it is expected to increase expenses, growing by 54% substantially.[ 18 ] The economic burden of atherosclerotic diseases in Brazil is expected to continue growing, driven by rising medical costs and the high number of hospital admissions. There is an ongoing trend where IHD remains the most significant contributor to direct and indirect costs, emphasizing the need for targeted interventions. This study has some limitations. It relies on data from various sources, including DATASUS and the TISS database, with different periods of availability for each (SUS data from 2008 onwards and ANS data from 2015 to 2022). The lack of consistent data across both systems and the absence of data from 2023 for ANS may introduce some bias or discrepancies in the analysis. Additionally, the impact of the COVID-19 pandemic on healthcare utilization, particularly in SUS data from 2020 and 2021, may affect the accuracy and comparability of hospitalization and cost trends. The study estimates indirect costs using certain assumptions, such as Brazil's average monthly wage and annual absenteeism period of 3.4 months. However, these assumptions may only partially capture the variability across different regions of Brazil or among different socioeconomic groups, leading to potential over- or underestimation of absenteeism-related costs. While the study focuses on direct and indirect costs, intangible costs such as pain, suffering, and reduced quality of life due to CVDs are omitted. These are essential components of the total economic burden of CVDs and could provide a more comprehensive understanding of the disease's societal impact. The data on social security benefits is limited to 2017 to 2022, which may only partially capture long-term trends or the impact of more recent policy changes. Additionally, categorizing benefits by disease may not capture all relevant aspects of the social costs associated with CVDs, such as disability benefits or long-term care costs. CONCLUSIONS In conclusion, atherosclerotic diseases represent a significant and growing economic burden in Brazil, with annual costs nearing BRL 10 billion and projections indicating an increase to BRL 60 billion over the next five years. Direct medical costs, particularly in the public healthcare system (SUS), dominate the financial impact, while indirect costs related to premature death and productivity losses are equally substantial. The high mortality among economically active individuals further exacerbates the societal and economic costs. The disparity in costs between public and private healthcare systems underscores the need for sustainable health policies. Targeted prevention, early diagnosis, and treatment interventions are essential to mitigate these costs. Addressing both direct and indirect financial burdens is critical to ensuring the sustainability of Brazil's healthcare system. Declarations Ethics approval and consent to participate This is a study based on anonymized, publicly available secondary dataset. Therefore, submission to the responsible Ethics Committee was not required, which is in compliance with local laws and regulations. Consent for publication All author consent with publication. Funding This study was funded by Novartis Pharmaceuticals (Brazil). Acknowledgement NA References Siqueira A, de SE AG, Land MGP. Análise do impacto econômico das doenças cardiovasculares nos últimos cinco anos no brasil. Arq Bras Cardiol. 2017;109:39–46. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76:2982–3021. Rodrigues HBO, Cruz ACC, Paschoal JFB, Santos IP, Soler IO, Ferreira BM, et al. The Epidemiology of Heart Disease in Brazil Between 2021 and 2022. Int J Med Sci Clin Res Stud. 2023;3(11 SE–Articles):2662–8. Badesha AS, Frood R, Bailey MA, Coughlin PM, Scarsbrook AF. A Scoping Review of Machine-Learning Derived Radiomic Analysis of CT and PET Imaging to Investigate Atherosclerotic Cardiovascular Disease. Tomography. 2024;10:1455–87. Marinho FO. Impacto Das Doenças Cardiovasculares Nas Perdas Econômicas. Arq Bras Cardiol. 2024;121:e20240175. Bandeira TFG, de Mosegui S, Vianna GBG, de López CM. Estimated Loss of Productivity Attributed to Cardiovascular Diseases in South America. Arq Bras Cardiol. 2024;121:e20230521. Stevens B, Pezzullo L, Verdian L, Tomlinson J, George A, Bacal F. The Economic Burden of Heart Conditions in Brazil. Arq Bras Cardiol. 2018;111. Ministério da Saúde (Brasil). Departamento de Informática do Sistema Único de Saúde (DATASUS). Tabnet. 2024. https://datasus.saude.gov.br/informacoes-de-saude-tabnet/ . Accessed 18 Dec 2024. Governo Federal (Brasil). Dados Abertos. Procedimentos Hospitalares por UF. 2024. https://dados.gov.br/dados/conjuntos-dados/procedimentos-hospitalares-por-uf . Accessed 18 Dec 2024. Governo Federal (Brasil). Ministério da Previdência Social. AEPS InfoLogo. 2024. https://www3.dataprev.gov.br/infologo/inicio.htm#:~:text=7413107852447652314 . Accessed 18 Dec 2024. IBGE. Tábuas Completas de Mortalidade. IBGE. https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fftp.ibge.gov.br%2FTabuas_Completas_de_Mortalidade%2FTabuas_Completas_de_Mortalidade_2022%2Fods%2Fambos_os_sexos.ods&wdOrigin=BROWSELINK . Accessed 10 Oct 2024. IBGE. PNAD Contínua - Pesquisa Nacional por Amostra de Domicílios Contínua. Instituto Brasileiro de Geografia e Estatística. 2023. https://www.ibge.gov.br/estatisticas/sociais/trabalho/17270-pnad-continua.html . Accessed 10 Oct 2024. Teich V, Araujo DV. Estimativa de custo da síndrome coronariana aguda no Brasil. Rev bras cardiol. 2011;24:85–94. Holt CC. Forecasting seasonals and trends by exponentially weighted moving averages. Int J Forecast. 2004;20:5–10. R Core Team. A Language and Environment for Statistical Computing. 2024. Forecast. Forecast. GitHub. Gheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health. 2018;18:975. Kazi DS, Elkind MSV, Deutsch A, Dowd WN, Heidenreich P, Khavjou O et al. Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association. Circulation. 2024;150. Azambuja MIR, Foppa M, Maranhão MF, de Achutti C. Impacto econômico dos casos de doença cardiovascular grave no Brasil: uma estimativa baseada em dados secundários. Arq Bras Cardiol. 2008;91:163–71. Luengo-Fernandez R, Walli-Attaei M, Gray A, Torbica A, Maggioni AP, Huculeci R, et al. Economic burden of cardiovascular diseases in the European Union: a population-based cost study. Eur Heart J. 2023;44:4752–67. Additional Declarations Competing interest reported. Alessandro Bigoni, and Ione Ayala Gualandi de Oliveira are Novartis’ employees. Alessandro Bigoni holds a position as research scholar at the Harvard Healthcare System Innovation Lab (HSIL). Neither Harvard nor the HSIL were involved in this manuscript. Cite Share Download PDF Status: Published Journal Publication published 02 Apr, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 12 May, 2025 Reviews received at journal 04 May, 2025 Reviews received at journal 01 May, 2025 Reviewers agreed at journal 21 Apr, 2025 Reviewers agreed at journal 20 Apr, 2025 Reviewers invited by journal 04 Apr, 2025 Editor invited by journal 01 Apr, 2025 Editor assigned by journal 31 Mar, 2025 Submission checks completed at journal 31 Mar, 2025 First submitted to journal 25 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6303694","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":438366918,"identity":"4b47696e-abab-42b6-86ab-417aa60460f9","order_by":0,"name":"Alessandro Bigoni","email":"","orcid":"","institution":"Novartis (Brazil)","correspondingAuthor":false,"prefix":"","firstName":"Alessandro","middleName":"","lastName":"Bigoni","suffix":""},{"id":438366921,"identity":"3b171caa-b97d-4523-9fac-6d56cadc4d29","order_by":1,"name":"Lucas Fahham","email":"","orcid":"","institution":"ORIGIN Health","correspondingAuthor":false,"prefix":"","firstName":"Lucas","middleName":"","lastName":"Fahham","suffix":""},{"id":438366923,"identity":"0d0d2c75-594f-4f92-aa96-943d2a704cb2","order_by":2,"name":"Ana Carolina Padula","email":"","orcid":"","institution":"ORIGIN Health","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Carolina","lastName":"Padula","suffix":""},{"id":438366925,"identity":"a4fca5d9-0865-4d37-a3b3-9303f6eab4ec","order_by":3,"name":"Ione Ayala Gualandi Oliveira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYBACNghlwcPAwNjAwFABFU4grEUCquUMmMfYgE8LFEhAKMY2qBZ8avnYew8+YKiQkDE43tz24ee8O3IGx88+f/DgD4M8v9gB7A7jOZdswHBGgsfgzMHmmb3bnhkbnEk3bEhsYzCcORu789gkcswkGNskeCRnJDYz8G47nDizIY2xIbGBIcHgNk4t5j/AWuY/bGb8Oweopf8Z0Pt/8GoxYwBp4ZdgbGbmbTic2C8BtCWBDY8WnjPGEglAv/DzJDYzyxw7bMwv8YxxRmKbBE6/yLf3GH74UGFjz8Z+/DHjm5rDcmz8aQwff/yxkeeXxq4FDLBJSeBWPgpGwSgYBaOAIAAA3hJVKOIRP7wAAAAASUVORK5CYII=","orcid":"","institution":"Novartis (Brazil)","correspondingAuthor":true,"prefix":"","firstName":"Ione","middleName":"Ayala Gualandi","lastName":"Oliveira","suffix":""}],"badges":[],"createdAt":"2025-03-25 12:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6303694/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6303694/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-026-14315-6","type":"published","date":"2026-04-02T15:58:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80140161,"identity":"8d7b70b7-6296-41b2-9680-f38022e02cca","added_by":"auto","created_at":"2025-04-08 11:13:09","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":118601,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDeath distribution by age group.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6303694/v1/b62ada30bebba2bfc0ef9ae4.jpeg"},{"id":106343584,"identity":"e26da5be-c7a0-4499-953b-86dd58681738","added_by":"auto","created_at":"2026-04-07 16:06:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1222743,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6303694/v1/c24bd336-22a9-4a65-9e9b-f01e437d2d46.pdf"}],"financialInterests":"Competing interest reported. Alessandro Bigoni, and Ione Ayala Gualandi de Oliveira are Novartis’ employees. Alessandro Bigoni holds a position as research scholar at the Harvard Healthcare System Innovation Lab (HSIL). Neither Harvard nor the HSIL were involved in this manuscript.","formattedTitle":"\u003cp\u003eCosts Related to Atherosclerotic Cardiovascular Disease in Brazil: Analysis From the Perspective of the Society\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNon-communicable chronic diseases (NCDs) - mainly represented by cardiovascular disease (CVD), cancer, and chronic respiratory diseases - causes approximately 38\u0026nbsp;million deaths annually, being the leading cause of death worldwide.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] The Brazilian Society of Cardiology (SBC) estimates that almost 400,000 Brazilian citizens die each year from heart and circulatory diseases. Among these pathologies, the vast majority (76%) is represented by atherosclerotic cardiovascular disease (ASCVD).[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] In Brazil, the most common form of ASCVD is acute myocardial infarction and heart failure.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eASCVD affect the carotid, coronary, aorta, and peripheral arteries.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] The main symptoms are chest pain, edema, limb pain, palpitation, and syncope. There has been a high prevalence of risk factors for these diseases in the last two decades, such as obesity, sedentary lifestyle, smoking. and poor diet.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eCVDs are a public health concern that impacts the population\u0026rsquo;s health and economy.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Globally, an increase in the number of deaths due to CVD from 12.1\u0026nbsp;million (95% CI: 11.4 to 12.6\u0026nbsp;million) in 1990 to 18.6\u0026nbsp;million (95% CI: 17.1 to 19.7\u0026nbsp;million) in 2019 is observed.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] In addition to premature deaths, individuals at high cardiovascular risk experience more lost working hours and higher indirect costs compared to those without cardiovascular events.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Consistently, significant increases are in the global trends for disability-adjusted life years (DALYs) and years of life lost. Years lived with disability doubled from 17.7\u0026nbsp;million (95% CI: 12.9 to 22.5\u0026nbsp;million) to 34.4\u0026nbsp;million (95% CI: 24.9 to 43.6\u0026nbsp;million) between 1990 and 2019.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eConsidering the specific context of South America, an important burden due to CVD is also observed. Marinho (2023) reported in an editorial that considering 2019 alone, over 750,000 deaths were attributed to CVD. This accounts for approximately 2,040,973 years of potential life lost (YPLL). Regarding productivity loss, the author described that this outcome imposed an economic impact equivalent to 0.11% of the region's gross domestic product (GDP), translating to an estimated cost of nearly 4\u0026nbsp;billion USD in purchasing power parity.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn Brazil, the economic burden of four heart conditions (hypertension, heart failure, myocardial infarction, and atrial fibrillation) was estimated at 56\u0026nbsp;million Brazilian real (BRL) in 2015, considering both direct and indirect costs.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Additionally, the cost of hospitalizations for cardiovascular diseases is considered the highest among the causes of hospital admissions in Brazil.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] A continuous understanding on the burden of a given disease is necessary to propose public policies related to disease management. Based on data from DATASUS, this study estimated the costs associated with ASCVD in Brazil, considering the perspective of the society.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData sources\u003c/h2\u003e \u003cp\u003eThis analysis used data from 2008 until 2023, however, the period varied depending on the dataset used. This study focuses on 3 main groups of atherosclerotic cardiovascular diseases, which were extracted from the databases considering the following ICD-10 codes as the main diagnosis: ischemic heart disease (IHD; I20, I21, I22, I24 e I25); ischemic stroke (IS; I64); and peripheral arterial disease (PAD; I73).\u003c/p\u003e \u003cp\u003eThe DATASUS hospital database was used to quantify direct costs in the Brazilian Unified Health System (SUS). This public, anonymized database used for reimbursement purposes aggregates data on all hospital procedures performed within SUS from 2008 to now. In addition to information such as the procedures performed, the main diagnosis (using the ICD-10 code), and the patient's demographic details, the database also includes information about the healthcare provider and the costs related to the treatment. Documentation with more information on the database can be accessed at the Brazilian Ministry of Health website.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe estimations of direct cost for the Brazilian private health system (ANS) was based on the TISS database [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], a standard for information exchange in the private healthcare system. The database includes information like the quantity and fees paid by the health operators to the healthcare providers for the performed procedures. Other information, such as patient demographics and diagnostics, is also provided. Data is available from 2015 to 2022.\u003c/p\u003e \u003cp\u003eSocial security benefits paid by the Brazilian government were extracted by ICD-10 and a year from Infologo [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], a public system provided by the Brazilian Ministry of Social Security, which aggregates all benefits paid by the government to the Brazilian population.\u003c/p\u003e \u003cp\u003eIndirect costs related to mortality were based on the 2022 projected life expectancy from the Brazilian Mortality Tables provided by the Brazilian Institute of Geography and Statistics (IBGE).[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Deaths caused by cardiovascular disease were evaluated by the patient's age, considering data from the Mortality Information System (SIM) death certificates. This centralized database has gathered information from all Brazilian territories since 1975.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHospital admissions\u003c/h3\u003e\n\u003cp\u003eThe number of hospital admissions was calculated based on the databases above, considering the relevant ICD-10 codes, and quantified annually from 2010 to 2023 for SUS and 2018 to 2022 for ANS. The difference in the periods evaluated is due to 1) the availability of a longer follow-up period for SUS and 2) a more pronounced bias from the pandemic period (2020 and 2021) in the SUS data rather than on ANS. The number of hospital admissions was segmented by type of ASCVD (IHD, IS, or PAD).\u003c/p\u003e\n\u003ch3\u003eDirect costs\u003c/h3\u003e\n\u003cp\u003eThe costs were quantified as the total cost of ASCVD by year and the average cost per hospitalization. They were also segmented by type of ASCVD (IHD, IS, or PAD).\u003c/p\u003e\n\u003ch3\u003eIndirect costs\u003c/h3\u003e\n\u003cp\u003eIndirect costs were divided into two categories: productivity loss due to death (projected productivity for an individual of working age who can no longer produce due to premature death) and productivity loss related to temporary work absence due to illness (absenteeism).\u003c/p\u003e \u003cp\u003eThe productivity loss due to death considered working age individuals between 14 and 64 years old, as defined by IBGE in its Continuous National Household Sample Survey (PNAD). [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe cost of productivity loss due to death was estimated by calculating the productive years lost due to premature death (defined as 64 minus the patient's age at death), multiplied by the average annual salary in Brazil in the 2nd quarter of 2024 (BRL 37,356.00), using a present value discount rate of 5% per year.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] This same methodology was used in other studies assessing Brazil's cardiovascular disease burden.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eProductivity loss related to absenteeism was calculated based on the number of hospitalizations per year for the mentioned ICD-10 codes, both in the public (SUS) and private (ANS) healthcare systems, multiplied by the average monthly wage in Brazil (BRL 3,113.00) in the second half of 2024, and by an average work absence period of 3.4 months.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eSocial security benefits\u003c/h3\u003e\n\u003cp\u003eTo estimate the impact of temporary leave (sick leave) and permanent leave (retirements), information available on the Social Security website (Infologo) was used. An analysis was conducted on the number of benefits granted for ASCVD defined by the predefined ICD-10 codes. The aggregated benefits paid by ASCVD disease groups were analyzed by year, considering the period between 2017 and 2022, the latest year where data was available.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eProjections\u003c/h2\u003e \u003cp\u003eBased on the historical data available from the various data sources used in this analysis, a projection of the costs related to ASCVD for the next five years (2025\u0026ndash;2029) was made.\u003c/p\u003e \u003cp\u003eCosts were forecasted based on historical data using the ETS (Error, Trend, and Seasonality) method, an exponential smoothing methodology, and Holt\u0026rsquo;s model, which can be helpful when a clear trend can be seen in the data.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eForecasting was done using R, version 4.4.1, using the package \u003cem\u003eforecast.\u003c/em\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDirect medical costs\u003c/h2\u003e \u003cp\u003eASCVD is responsible for more than 600,000 hospitalizations per year in Brazil (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), most of them in SUS (82%), which is compatible with the private system coverage (approximately 25% of the Brazilian population is covered by a private healthcare plan). Nevertheless, ANS presents costs approximately 30% higher than those seen in SUS. IHD shows the highest costs, while PAD is the lowest (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHospital admissions by ASCVD.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital admissions by ASCVD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2026\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2027\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2028\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2029\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e514.626\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e523.517\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e532.408\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e541.300\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e550.191\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIschemic heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e300.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e303.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e305.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e308.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e311.814\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIschemic stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e195.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e200.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e205.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e210.451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e215.547\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral arterial disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22.831\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e110.843\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e114.255\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e117.668\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e121.081\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e124.493\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIschemic heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e87.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIschemic stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e31.534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral arterial disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal (SUS\u0026thinsp;+\u0026thinsp;ANS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e625.468\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e637.772\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e650.076\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e662.380\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e674.684\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDirect medical costs by ASCVD (BRL).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital admissions by ASCVD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2026\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2027\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2028\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2029\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.116.507.233\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.215.411.514\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.314.315.795\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.413.220.077\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.512.124.358\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e351.333.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e365.159.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e378.985.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e392.811.380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e406.637.377\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47.828.818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.186.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.544.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e51.902.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e53.260.785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.717.345.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 801.065.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.884.785.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.968.505.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.052.226.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.803.244.273\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.959.793.909\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3.116.343.545\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.272.893.181\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.429.442.817\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e956.162.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.002.213.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.048.265.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.094.316.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.140.367.943\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95.928.938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104.634.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e113.340.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e122.045.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e130.751.366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.751.152.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.852.945.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.954.738.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.056.530.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.158.323.508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal (SUS\u0026thinsp;+\u0026thinsp;ANS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.919.751.506\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5.175.205.423\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e5.430.659.340\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5.686.113.258\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e5.941.567.175\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDeath-related indirect costs\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the distribution of death from ASCVD in 2023 by age group. Approximately 30% occurred in patients in the economic active range (from 14 to 64 years old). Indirect costs related to death represent almost BRL 4\u0026nbsp;billion per year (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), the same magnitude as all direct medical costs.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndirect costs related to death (BRL).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2026\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2027\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2028\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2029\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e591.029.604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e593.744.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e596.335.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e598.798.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e601.134.239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.583.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.277.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.894.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45.432.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e46.890.431\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.641.542.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.663.409.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.684.278.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.704.123.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.722.936.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4,273,155,115\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.299.430.954\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.324.508.087\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4.348.355.164\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4.370.961.370\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAbsenteeism-related indirect costs\u003c/h2\u003e \u003cp\u003eConsidering the average wage in Brazil (BRL 3,113.00), the number of hospital admissions, and the average recovery time of 3.4 months, absenteeism-related indirect costs represent approximately BRL 181\u0026nbsp;million per year (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), which can be considered a lower cost besides the magnitude of direct medical costs and indirect costs related to death. An interesting trend can be noted that absenteeism-related costs are decreasing with time, which may be linked to an increase in mortality observed in patients with IHD.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndirect costs related to absenteeism (BRL).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2026\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2027\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2028\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2029\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143.645.826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143.664.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e143.697.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e143.745.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e143.808.555\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.885.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.940.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.006.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.084.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14.173.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.253.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.361.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.575.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.898.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.331.859\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e184.785.097\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e182.966.751\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e181.280.110\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e179.728.597\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e178.313.444\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocial Security-related costs\u003c/h2\u003e \u003cp\u003eSocial security benefits paid to patients with ASCVD represent approximately BRL 100\u0026nbsp;million annually (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), with IHD being the most relevant disease regarding paid benefits.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocial security benefits paid (BRL).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2026\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2027\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2028\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2029\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59.584.840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.277.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.969.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e64.661.447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e66.353.707\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.098.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.337.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.576.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31.815.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33.054.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.298.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.374.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.449.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.525.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.601.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e89.981.840\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e92.988.607\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e95.995.374\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e99.002.168\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e102.008.992\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEconomic burden of ASCVD in Brazil\u003c/h2\u003e \u003cp\u003eThe economic burden of ASCVD in Brazil is approximately BRL 10\u0026nbsp;billion annually, most related to indirect medical costs. The country is expected to spend around BRL 60\u0026nbsp;billion on the disease in the next five years (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEconomic burden of ASCVD in Brazil (BRL).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2026\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2027\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2028\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2029\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect medical costs - SUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.116.507.233\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.215.411.514\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.314.315.795\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.413.220.077\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.512.124.358\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e13.589.181.928\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e351.333.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e365.159.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e378.985.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e392.811.380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e406.637.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.232.434.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47.828.818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.186.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.544.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e51.902.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e53.260.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e299.194.834\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.717.345.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.801.065.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.884.785.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.968.505.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.052.226.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11.057.552.791\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect medical costs - ANS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.803.244.273\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.959.793.909\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3.116.343.545\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.272.893.181\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.429.442.817\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e18.228.412.362\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e956.162.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.002.213.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.04.8265.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.094.316.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.140.367.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6.151.437.436\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95.928.938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104.634.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e113.340.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e122.045.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e130.751.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e653.924.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.751.152.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.852.945.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.954.738.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.056.530.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.158.323.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11.423.050.835\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.547.922.052\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.575.386.312\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.601.783.571\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4.627.085.929\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4.651.283.806\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e27.571.064.629\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.273.155.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.299.430.954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.324.508.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.348.355.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.370.961.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25.862.122.669\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsenteeism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184.785.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182.966.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e181.280.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e179.728.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e178.313.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.144.800.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial security\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89.981.840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.988.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95.995.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99.002.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e102.008.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e564.141.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e9.467.673.558\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e9.750.591.735\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e10.032.442.911\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e10.313.199.187\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e10.592.850.981\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e59.388.658.919\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBRL: Brazilian real; IS: ischemic stroke; PAD: peripheral artery disease; IHD: ischemic heart disease.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAtherosclerotic cardiovascular diseases (IHD, IS, and PAD) represent a significant economic burden in Brazil, totaling a cost of approximately BRL 10\u0026nbsp;billion per year (approximately 2\u0026nbsp;billion dollars, considering an exchange rate of USD 1\u0026thinsp;=\u0026thinsp;BRL 5.08). Indirect medical costs, including mortality-related and absenteeism-related costs primarily drive the costs.\u003c/p\u003e \u003cp\u003eDirect medical costs are substantial and growing, particularly within SUS, which covers much of the Brazilian population. SUS accounts for most hospital admissions related to atherosclerotic diseases (82%). The direct costs are higher in ANS than in SUS, with IHD incurring the highest costs and PAD the lowest The breakdown by disease type shows a marked dominance of IHD in both direct medical costs and hospital admissions.\u003c/p\u003e \u003cp\u003eStevens et al. (2018) conducted a similar study, with the aim to assess the economic burden of heart conditions in Brazil, under the perspective of the society. Costs associated with the management of hypertension, heart failure, myocardial infarction, and atrial fibrillation were calculated. Total cost estimated for 2015 was BRL 56\u0026nbsp;million (approximately 11\u0026nbsp;million, considering an exchange rate of BRL 1\u0026thinsp;=\u0026thinsp;BRL 5.08) and health system costs represented 63% of this amount. Myocardial infarction was responsible for the highest amount.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Despite different conditions have been assessed, IHD, IS and PAD in our analysis and hypertension, heart failure, myocardial infarction, and atrial fibrillation in the former study, it is possible to highlight an increase in the costs.\u003c/p\u003e \u003cp\u003eGheorghe et al. (2018) systematically reviewed the literature to understand the economic burden of the cardiovascular diseases and hypertension in low and middle income countries. Stroke and coronary heart disease imposed the higher direct costs, when compared to hypertension, heart failure and generic cardiovascular diseases. An important variation on estimated cost is observed. For example, the ratio of annual cost of care to country-specific total health expenditure per capita ranges from 4.48 to 472.48 international dollars.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Such results highlights that there is still a gap on the knowledge on the burden of cardiovascular diseases in these countries and further analysis are needed to suggest initiatives to decrease such impact.\u003c/p\u003e \u003cp\u003eIn the present analysis, an increment on costs related to cardiovascular diseases management was shown in the 2025\u0026ndash;2029 period. An analysis in the United States showed that, for cardiovascular conditions, annual healthcare costs are projected to nearly quadruple, from 393\u0026nbsp;billion USD to 1,490\u0026nbsp;billion USD, between 2020 and 2050.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Disregarding the large difference between the values, a large increase in the cost of cardiovascular diseases is also expected in the United States, as this study showed regarding these costs in Brazil. In the United States, stroke is projected to account for the largest absolute cost increase, unlike in Brazil, where IHD was the most significant contributor. Further studies are needed to understand reasons for the increase of burden in each disease.\u003c/p\u003e \u003cp\u003eFurthermore, social security benefits paid to individuals with atherosclerotic diseases are around BRL 100\u0026nbsp;million annually. This represents another dimension of the indirect costs to the Brazilian economy. In 2022, the total amount paid by the Brazilian social security system was BRL 3,728,378,420.24. Diseases of the circulatory system represented 6% of this total, which corresponds to BRL 222,170,309.50. Other causes such as neoplasms and diseases of the respiratory system represented 7% (BRL 262,703,687.06) and 0.8% (BRL 29,163,148.34), respectively.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Azambuja et al. (2018) reported that severe cardiovascular diseases imposed a financial burden of BRL 2.57\u0026nbsp;billion on Brazilian social security, accounting for 0.16% of the country\u0026rsquo;s gross domestic product.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] In the European Union (EU), cardiovascular diseases resulted in an estimated cost of \u0026euro;155\u0026nbsp;billion to the EU's health and social care systems, representing 11% of the total healthcare expenditure in 2021.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe implications of high mortality rates among the economically active age group due to atherosclerotic diseases have a broader socioeconomic impact, including the loss of a productive workforce. Death-related indirect costs are significant, mainly because approximately 30% of deaths from atherosclerotic diseases occur in the economically active age group (14\u0026ndash;64 years old), contributing to nearly BRL 4\u0026nbsp;billion annually in indirect costs. This is comparable to the direct medical costs.\u003c/p\u003e \u003cp\u003eMoreover, absenteeism-related costs are much lower than death-related costs, which are still notable (about BRL 180\u0026nbsp;million). This cost aligns with a study conducted in South America, which estimated that the annual productivity loss due to CVDs was around 3.7\u0026nbsp;billion USD.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] This research highlighted Brazil and Argentina as the countries most impacted by productivity reductions, underscoring the detrimental effects of CVDs on economic growth.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] However, few studies have examined the productivity losses associated with CVDs in South America. On the other hand, the USA's productivity losses due to CVDs are projected to rise from 234\u0026nbsp;billion USD to 361\u0026nbsp;billion USD/year between 2020 and 2050. Despite the significant amount, it is expected to increase expenses, growing by 54% substantially.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe economic burden of atherosclerotic diseases in Brazil is expected to continue growing, driven by rising medical costs and the high number of hospital admissions. There is an ongoing trend where IHD remains the most significant contributor to direct and indirect costs, emphasizing the need for targeted interventions.\u003c/p\u003e \u003cp\u003eThis study has some limitations. It relies on data from various sources, including DATASUS and the TISS database, with different periods of availability for each (SUS data from 2008 onwards and ANS data from 2015 to 2022). The lack of consistent data across both systems and the absence of data from 2023 for ANS may introduce some bias or discrepancies in the analysis. Additionally, the impact of the COVID-19 pandemic on healthcare utilization, particularly in SUS data from 2020 and 2021, may affect the accuracy and comparability of hospitalization and cost trends. The study estimates indirect costs using certain assumptions, such as Brazil's average monthly wage and annual absenteeism period of 3.4 months. However, these assumptions may only partially capture the variability across different regions of Brazil or among different socioeconomic groups, leading to potential over- or underestimation of absenteeism-related costs. While the study focuses on direct and indirect costs, intangible costs such as pain, suffering, and reduced quality of life due to CVDs are omitted. These are essential components of the total economic burden of CVDs and could provide a more comprehensive understanding of the disease's societal impact. The data on social security benefits is limited to 2017 to 2022, which may only partially capture long-term trends or the impact of more recent policy changes. Additionally, categorizing benefits by disease may not capture all relevant aspects of the social costs associated with CVDs, such as disability benefits or long-term care costs.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn conclusion, atherosclerotic diseases represent a significant and growing economic burden in Brazil, with annual costs nearing BRL 10\u0026nbsp;billion and projections indicating an increase to BRL 60\u0026nbsp;billion over the next five years. Direct medical costs, particularly in the public healthcare system (SUS), dominate the financial impact, while indirect costs related to premature death and productivity losses are equally substantial. The high mortality among economically active individuals further exacerbates the societal and economic costs. The disparity in costs between public and private healthcare systems underscores the need for sustainable health policies. Targeted prevention, early diagnosis, and treatment interventions are essential to mitigate these costs. Addressing both direct and indirect financial burdens is critical to ensuring the sustainability of Brazil's healthcare system.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a study based on anonymized, publicly available secondary dataset. Therefore, submission to the responsible Ethics Committee was not required, which is in compliance with local laws and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll author consent with publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Funding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Novartis Pharmaceuticals (Brazil).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Acknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSiqueira A, de SE AG, Land MGP. An\u0026aacute;lise do impacto econ\u0026ocirc;mico das doen\u0026ccedil;as cardiovasculares nos \u0026uacute;ltimos cinco anos no brasil. Arq Bras Cardiol. 2017;109:39\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u0026ndash;2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76:2982\u0026ndash;3021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodrigues HBO, Cruz ACC, Paschoal JFB, Santos IP, Soler IO, Ferreira BM, et al. The Epidemiology of Heart Disease in Brazil Between 2021 and 2022. Int J Med Sci Clin Res Stud. 2023;3(11 SE\u0026ndash;Articles):2662\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBadesha AS, Frood R, Bailey MA, Coughlin PM, Scarsbrook AF. A Scoping Review of Machine-Learning Derived Radiomic Analysis of CT and PET Imaging to Investigate Atherosclerotic Cardiovascular Disease. 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Tabnet. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://datasus.saude.gov.br/informacoes-de-saude-tabnet/\u003c/span\u003e\u003cspan address=\"https://datasus.saude.gov.br/informacoes-de-saude-tabnet/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 18 Dec 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoverno Federal (Brasil). Dados Abertos. Procedimentos Hospitalares por UF. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dados.gov.br/dados/conjuntos-dados/procedimentos-hospitalares-por-uf\u003c/span\u003e\u003cspan address=\"https://dados.gov.br/dados/conjuntos-dados/procedimentos-hospitalares-por-uf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 18 Dec 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoverno Federal (Brasil). Minist\u0026eacute;rio da Previd\u0026ecirc;ncia Social. AEPS InfoLogo. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www3.dataprev.gov.br/infologo/inicio.htm#:~:text=7413107852447652314\u003c/span\u003e\u003cspan address=\"https://www3.dataprev.gov.br/infologo/inicio.htm#:~:text=7413107852447652314\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 18 Dec 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIBGE. T\u0026aacute;buas Completas de Mortalidade. 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Instituto Brasileiro de Geografia e Estat\u0026iacute;stica. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ibge.gov.br/estatisticas/sociais/trabalho/17270-pnad-continua.html\u003c/span\u003e\u003cspan address=\"https://www.ibge.gov.br/estatisticas/sociais/trabalho/17270-pnad-continua.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 10 Oct 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeich V, Araujo DV. Estimativa de custo da s\u0026iacute;ndrome coronariana aguda no Brasil. Rev bras cardiol. 2011;24:85\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolt CC. Forecasting seasonals and trends by exponentially weighted moving averages. Int J Forecast. 2004;20:5\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR Core Team. A Language and Environment for Statistical Computing. 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForecast. Forecast. GitHub.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health. 2018;18:975.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazi DS, Elkind MSV, Deutsch A, Dowd WN, Heidenreich P, Khavjou O et al. Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association. Circulation. 2024;150.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzambuja MIR, Foppa M, Maranh\u0026atilde;o MF, de Achutti C. Impacto econ\u0026ocirc;mico dos casos de doen\u0026ccedil;a cardiovascular grave no Brasil: uma estimativa baseada em dados secund\u0026aacute;rios. Arq Bras Cardiol. 2008;91:163\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuengo-Fernandez R, Walli-Attaei M, Gray A, Torbica A, Maggioni AP, Huculeci R, et al. Economic burden of cardiovascular diseases in the European Union: a population-based cost study. Eur Heart J. 2023;44:4752\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cardiovascular Diseases, Costs and Cost Analysis, Ischemic Heart Disease, Ischemic Stroke, Peripheral Arterial Disease","lastPublishedDoi":"10.21203/rs.3.rs-6303694/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6303694/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCardiovascular diseases are the leading cause of death globally. High-risk individuals face costs from premature death and productivity loss due to sick leave and retirement. In Brazil, the economic burden of hypertension, heart failure, myocardial infarction, and atrial fibrillation was estimated at 56\u0026nbsp;million Brazilian reais (BRL) in 2015, including both direct and indirect costs. Understanding the burden of a disease is essential for proposing effective public policies. Using DATASUS data, this study estimated the costs of atherosclerotic cardiovascular disease (ASCVD) in Brazil from a societal perspective.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis analysis used data from 2008 to 2023, focusing on three types of ASCVD: ischemic heart disease (IHD), ischemic stroke (IS), and peripheral arterial disease (PAD). The DATASUS hospital database was used to quantify direct costs in the public system and collect patient demographic details. Estimates for direct costs on the private system were based on the TISS database, while social security benefits were sourced from the Brazilian Ministry of Social Security.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eASCVD lead to over 600,000 hospitalizations annually in Brazil, predominantly in the public system (82%). Coronary Artery Disease (CHD) imposes the highest costs, while PAD incurs the lowest. Indirect costs related to death represent nearly BRL 4\u0026nbsp;billion annually, similar magnitude to all direct medical costs. The indirect costs from absenteeism are approximately BRL 181\u0026nbsp;million per year, significantly lower than the magnitude of direct medical and death-related indirect costs. There is a trend that shows that absenteeism-related costs are decreasing, possibly due to the increase in mortality rates in patients with IHD. In Brazil, social security benefits for cardiovascular diseases total about BRL 100\u0026nbsp;million annually, with IHD being the most significant. The annual economic burden of these diseases is around BRL 10\u0026nbsp;billion, expected to reach BRL 60\u0026nbsp;billion in the next five years.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn conclusion, ASCVD present a significant economic burden in Brazil, primarily through direct medical costs in the public system. Indirect costs from premature deaths and productivity losses are also substantial. The high mortality rate among economically active individuals worsens these impacts. To reduce costs, focusing on targeted prevention, early diagnosis, and effective treatment is essential.\u003c/p\u003e","manuscriptTitle":"Costs Related to Atherosclerotic Cardiovascular Disease in Brazil: Analysis From the Perspective of the Society","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-08 11:05:05","doi":"10.21203/rs.3.rs-6303694/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-12T06:15:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-04T15:59:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-01T18:19:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259620220248971401779704545255659023011","date":"2025-04-21T21:15:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232447580956704407157942017988756904036","date":"2025-04-20T11:46:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-04T09:13:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-01T09:08:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-31T07:04:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-31T07:04:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-03-25T12:07:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb33c989-218e-4aa2-af04-400f274793d1","owner":[],"postedDate":"April 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:03:09+00:00","versionOfRecord":{"articleIdentity":"rs-6303694","link":"https://doi.org/10.1186/s12913-026-14315-6","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-04-02 15:58:14","publishedOnDateReadable":"April 2nd, 2026"},"versionCreatedAt":"2025-04-08 11:05:05","video":"","vorDoi":"10.1186/s12913-026-14315-6","vorDoiUrl":"https://doi.org/10.1186/s12913-026-14315-6","workflowStages":[]},"version":"v1","identity":"rs-6303694","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6303694","identity":"rs-6303694","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}