Can Australia afford the costs of cardiology guidelines? True costs and strategies for reduction.

AIM: To estimate the 10-year Australian healthcare system cost of full implementation of evidence-based guidelines across five common cardiovascular conditions.

BACKGROUND

Healthcare spending in Australia continues to rise as the population ages and treatment options become increasingly advanced and costly. However, assessment of cost remains conspicuously absent from national and international clinical guidelines, and the implications of such costs for the equity and sustainability of healthcare have not been evaluated in the Australian context.

METHODS

Using national population estimates and Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data, we modelled the projected 10-year cost of full guideline implementation for all eligible or indicated Australians across five common cardiovascular conditions: dyslipidaemia, hypertension, obesity, type 2 diabetes with heart failure or chronic kidney disease, and atrial fibrillation/flutter. These costs were compared against PBS/MBS expenditure from 2024 to 2025.

RESULTS

In total, the projected 10-year cost for only these five cardiovascular conditions is estimated at $45-50 billion (at 2025 prices), which is 3.4-3.9 times higher than the current national expenditure for these conditions. This also highlights the poor uptake of, or access to, evidence-based care among certain Australian populations.

CONCLUSIONS

Our analysis highlights the complex balance between efficacy, cost and equity in healthcare. We propose two practical strategies to address these challenges: embedding cost-effectiveness analyses into guideline formulation and promoting greater use of generic medications. Through these measures, we hope to prioritise cost-effective, evidence-based care and make it accessible to all Australians, while maintaining the long-term financial sustainability of the healthcare system.