Prospects for Medical Advances
Affecting the Elderly
Dana P. Goldman
Acknowledgements
RAND
Michael Hurd
Constantijn Panis
Geoffrey Joyce
Baoping Shang
Emmett Keeler
Paul Shekelle
Darius Lakdawalla
Stanford
Jay Bhattacharya
Harvard
David Cutler
Alan Garber
Funding was provided by NIA through the RAND Roybal
Center for Health Policy Simulation and the RAND Aging
Center. Original model developed with funding by CMS.
Health Care Spending is Rising as a Share of
Economic Output
16
14.9
14
12
Health care
spending as
a percentage
of GDP
10
8
6
4
5.1
2
0
1960 1965 1970 1975 1980 1985 1990 1995 2000
Source: Centers for Medicare & Medicaid Services, 2004.
Infant mortality
Infant Deaths Per 1000 Live Births
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
1950
1960
1970
1980
1990
2000
A g e A d j u s te d C a r d io v a s c u la r D is e a s e D e a th s
Per 1000
On Average, Spending Is Worth It
Cardiovascular disease
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1950
1960
1970
1980
1990
2000
Note: Infants are under 1 year; Cardiovascular disease includes diseases of the heart and cerebrovascular diseases.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital
Statistics System: Arias E, Anderson RN, Kung HC, Murphy SL, Kochanek KD. Deaths: Final data for 2001.
National vital statistics reports. vol 52 no 3. Hyattsville, Maryland: National Center for Health Statistics.
2003.Table 22, 29: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/Health_US/hus03/
But Will Emerging Technologies Be
Worth the Cost?
The Left Ventricular Assist Device
Source: Rose et al, New Engl. J. of Med., 345(20);2001, Figure 1.
5
Research Objectives
• Identify the key biomedical innovations and
health trends likely to affect the elderly over
the next 30 years
• Model the effects on:
– Spending
– Disease
– Functional status
Convened Panels of Experts from
Around the Country
• Identified key breakthroughs in 3 clinical
areas:
– Cardiovascular disease
– Neurological disorders
– Cancer / biology of aging*
• Fourth panel of geriatricians and social
scientists
*Combined since cancer is now closely linked with the aging process at the
cellular level.
7
Example:
Intraventricular Defibrillators
Target:
50% of patients with heart failure
50% of patients post AMI
20% of patients with cardiomyopathy
Likelihood:
30% in 10 yrs
30-40% in 20 yrs
Impact:
Life expectancy of people with heart failure
increases 6-10 months
No impact on hospitalizations
Cost:
$35,000 - $40,000 per case
~3.5 million
in 2004
8
Our Model Tracks Individuals Over Time
New 65
year-olds
in 2006
100,000
Medicare
beneficiaries
(age 65+)
in 2005
Survivors
Health &
functional
Survivors
status, 2006
Health &
functional
status 2007
Deceased
Deceased
2005 costs
New 65
year-olds
in 2007
2006 costs
Etc.
Survivors
Deceased
2007 costs
Example 1:
Compound to Extend Lifespan
• Overwhelming biomedical evidence that
reducing caloric intake of animals by 30%
increases life expectancy by 25%
– Chemical compounds can mimic this behavior
in rodents
• Such a pill could emerge for humans
– Taken by everyone at a cost similar to
nutritional supplements ($1/day)
– Hazard of death decreases by 63%
(equivalent to extending life by 15 years)
10
Aged Population Would Grow by
13 Million by 2030
Total Number of Elderly (65+)
90
84
80
Compound
71
70
Population
60
(millions)
50
Status Quo
40
30
2000
2005
2010
2015
2020
2025
2030
Year
11
Much More Heart Disease
55
52
Compound
50
45
44
% with heart
disease
Status Quo
40
35
30
2000
2005
2010
2015
2020
2025
2030
Year
12
Health Care Spending
Would Be 70% Higher in 2030
Elderly Health Care Spending
1000
934
900
800
Billions
700
of 1998
dollars 600
Compound
621
500
400
Status Quo
300
2000
2005
2010
2015
2020
2025
2030
Year
13
Society Faces Substantial Technological Risk
In Elderly Medical Spending
Technology
Increase in
medical spending*
(%)
Cost per
additional
life-year
Anti-aging compound (healthy)
13.8
8,790
Anti-aging compound (unhealthy)
70.4
29,785
*Increase
in 2030 health care spending relative to status quo without the technology.
Source: Goldman et al, Health Affairs, forthcoming
Example 2:
Intraventricular Cardioverter Defibrillators
• Currently used to treat patients with lifethreatening arrhythmias
– Shocks heart to restore natural rhythm
– 26,000 procedures in 1988
– $35,000 per procedure
• Scenario would expand their use
– Implant in 50% of patients with heart failure or
myocardial infarction
– Reduces risk of death by 10%
• Panel told us 35% chance of such an expansion
15
Will Reach 350,000 Procedures Annually
by 2030
400,000
348,729
Number of Procedures
350,000
300,000
250,000
200,000
150,000
100,000
50,000
0
2000
2005
2010
2015
2020
2025
2030
Year
16
Will Add About $20 -$25 Billion Annually to
Health Spending in Steady-State
Elderly Health Care Spending
Billions of Dollars (1998)
675
635
621
600
525
450
ICD
Status Quo
375
300
2000
2005
2010
2015
2020
2025
2030
Year
17
Little Change in Functional Status
for the Elderly Population
Elderly With Any Functional Impairment
Prevalance (%)
30
29
28
27
26
ICD
Status Quo
25
24
2000
2005
2010
2015
2020
2025
2030
Year
18
Society Faces Substantial Technological Risk
In Elderly Medical Spending
Technology
Increase in
medical spending*
(%)
Cost per
additional
life-year
Anti-aging compound (healthy)
13.8
8,790
Anti-aging compound (unhealthy)
70.4
29,785
Implantable cardio-defibrillators
3.7
103,095
*Increase
in 2030 health care spending relative to status quo without the technology.
Source: Goldman et al, Health Affairs, forthcoming
Society Faces Substantial Technological Risk
In Elderly Medical Spending
Technology
Increase in
medical spending*
(%)
Cost per
additional
life-year
Anti-aging compound (healthy)
13.8
8,790
Cancer vaccines
0.4
18,236
Treatment of acute stroke
0.4
21,905
Anti-aging compound (unhealthy)
70.4
29,785
Telomerase inhibitors (cancer)
0.5
61,884
Implantable cardio-defibrillators
3.7
103,095
Antiangiogenesis (cancer)
8.0
498,809
Left ventricular assist devices
2.3
511,962
Pacemaker for atrial fibrillation
2.3
1,403,740
*Increase
in 2030 health care spending relative to status quo without the technology.
Source: Goldman et al, Health Affairs, forthcoming
Key Findings
• Substantial technological risk in Medicare
– Not just demographic risk caused by the
aging of baby boomers
• Living longer is valuable, but not because it
saves money
– Curing any one disease will not fix the
problem
– Obesity may be an important exception
• Challenge is to figure out how we get
treatment to the patients who most need it
21