Heart failure in China: a macroeconomic modelling study of intervention strategies

BACKGROUND AND AIMS: Heart failure (HF) imposes a growing public health and macroeconomic burden in low- and middle-income countries (LMICs), yet its long-term economic impact remains unquantified. China, characterized by rapid ageing and escalating cardiovascular risks, provides a critical setting to model HF economic implications. METHODS: Using data from the Global Burden of Disease Study 2021, China Cardiovascular Association Registry, and national insurance databases, HF macroeconomic burden (2025-35) was projected via a health-augmented macroeconomic model. Three interventions were evaluated: B-type natriuretic peptide (BNP) screening (adults ≥40 years), intensive blood pressure (BP) control (hypertensive patients), and guideline-directed medical therapy (GDMT) optimization for HF with reduced ejection fraction. Costs are reported in 2017 international dollars (INT$). RESULTS: By 2035, HF cases in China will reach 22.7 million [95% uncertainty interval (UI): 9.5-36.9 million], with an age-standardized prevalence of 760.65/100 000 (95% UI: 283.2-1340.8/100 000). The cumulative economic burden (2025-35) is INT$1001.1 billion (95% UI: 733.4-1365.6 billion), representing 0.26% of gross domestic product (95% UI: 0.19%-0.34%), driven by labour force attrition (72.1%; 95% UI: 64.4%-74.8%). Interventions reduced the total burden by 12.5% (95% UI: 10.4%-14.5%): BNP screening (25% coverage) saved INT$78.5 billion (95% UI: 62.8-94.1 billion; 8.10% reduction; cost-benefit ratio 0.49), Intensive BP control saved INT$27.5 billion (95% UI: 25.1-29.9 billion; 2.74% reduction; ratio 0.22), GDMT optimization saved INT$17.0 billion (95% UI: 12.8-22.4 billion; 1.70% reduction; ratio 0.48). CONCLUSIONS: HF imposes a substantial and increasing macroeconomic burden in China, largely through workforce productivity losses. Scalable, cost-effective strategies, including primary care-based BNP screening, subsidized hypertension control, and enhanced GDMT adherence, are essential to curb economic losses. These findings inform policy priorities for China and other LMICs confronting demographic transitions.