Getting to the heart of the matter: medicines save lives and money

John J. Castellani explores the potential of novel cardiovascular disease treatments currently under development.

We all know someone who has had a heart attack, a stroke, is battling high cholesterol or is living with dangerously high blood pressure. Each takes a tremendous toll on patients and their families, and contributes greatly to rising healthcare costs. However, new data reinforce how innovative medicines are an important part of the solution to these growing public health challenges.

A recent report reveals that biopharmaceutical research companies are hard at work developing 215 new medicines for heart disease and stroke, including heart failure, lipid disorders (such as high cholesterol), high blood pressure and ischemic disorders.1

The exciting, novel medicines in today’s R&D pipeline hold the potential to deliver to patients better options to prevent and treat cardiovascular disease. Among the medicines now in clinical trials or under review by the U.S. Food and Drug Administration are a novel gene therapy that uses a patient’s own cells to treat heart failure, a medicine that blocks the transfer of good (HDL) cholesterol to bad (LDL), and a genetically-engineered medicine that dissolves clots to treat stroke.

These promising medicines build on our growing understanding of the molecular underpinnings of disease and medical progress achieved to date, provide real hope to patients – and perhaps better still – represent new opportunities to prevent people from becoming patients.

Death rates from heart disease and stroke are falling in the U.S., largely due to innovative medicines that help control blood pressure and cholesterol, according to the National Heart, Lung and Blood Institute. Still, heart disease has topped the list of deadly diseases every year since 1921.2

“…biopharmaceutical research companies are hard at work developing 215 new medicines for heart disease and stroke…”

Here’s a particularly sobering fact: an American dies from cardiovascular disease every 39 seconds, and more than 83 million Americans have at least one form of the disease.3

And it’s a global problem. Heart disease remains the leading cause of early death in Europe, accounting for over 4 million deaths each year.4Nearly half of all European deaths are the result of cardiovascular disease.

But the impact of heart disease is not limited to just patients and their families. Treating cardiovascular disease costs the U.S. more than $312 billion a year – and it’s increasing. Annual costs of stroke-related care could increase by 129% to $240 billion by 2030, while costs associated with congestive heart failure (CHF) could more than double to $70 billion by 2030.3

Innovative medicines can help bend this cost curve.

A recent Congressional Budget Office (CBO) report recognized how use of medicines can reduce spending on other medical services in Medicare. Citing the growing body of evidence demonstrating the cost benefits of improving access to medicines, the CBO updated its methodology for calculating the cost of Medicare policies. For the first time, CBO is accounting for the positive savings from use of medicines that reduce the need for other costly medical services, such as hospitalizations.

The potential savings are magnified within certain chronic diseases, such as congestive heart failure (CHF).

CHF patients are among the most expensive to treat. Several studies have found that savings can be realized from reducing hospitalizations, surgeries and emergency room use – all key drivers of the high costs of CHF.

Interestingly, research also shows that innovative medicines have helped limit symptoms while decreasing hospital readmission rates. And if used early, these medicines play an important role in preventing CHF from developing in the first place.

“…heart disease has topped the list of deadly diseases every year but one since 1900…”

Most recently, a study published last month in the American Journal of Managed Care found that improved adherence to medication following the expansion of the Medicare Part D prescription drug program led to savings of nearly $2.6 billion in annual medical spending among beneficiaries with CHF. The study also found that further improving adherence to medicines could save Medicare another $1.9 billion annually, leading to $22.4 billion over 10 years.5

Add this all up and the conclusions are eye-opening: medical progress against cardiovascular disease and other chronic conditions is improving patients’ lives and helping to control health care costs. Best yet, the new medicines in the pipeline have the potential to continue this remarkable public health story.

But here’s the catch: to fully realize the benefits of medical innovation, we must have long-term, interdependent and integrated policies that nurture the innovative process – including a system that properly values medicines.

This value proposition is critical – and I believe it’s a potential game-changer. The dynamic evidence that innovative medicines – such as those targeting heart disease – result in better health outcomes while reducing costs is increasingly compelling.

Our task going forward is to help policymakers, thought leaders, patients and other stakeholders recognize the importance of policies that properly value medicines. We welcome the challenge.


1. Pharmaceutical Research and Manufacturers of America, 2013 Medicines in Development for Heart Disease and Stroke Report. Available from

2. Centers for Disease Control and Prevention, National Center for Health Statistics Data. Available at

3. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013; 127:e6-e245.

4. Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Gray A, Scarborough P, Rayner M (2012). European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis

5. Timothy M. Dall, MS; Tericke D. Blanchard, MBA; Paul D. Gallo, BS; and April P. Semilla, MS, “The Economic Impact of Medicare Part D on Congestive Heart Failure,” American Journal of Managed Care 2013;19: S97-S100




About the author:

John Castellani is the President &, Chief Executive Officer of the Pharmaceutical Research and Manufacturers of America (PhRMA), position he has held since August 2010.

Before joining PhRMA, Castellani was President and Chief Executive Officer of the Business Roundtable (BRT), an association of Chief Executive Officers from leading U.S. corporations and cited by the Financial Times as “the most influential chief executive lobbying group in the U.S.”. Prior to the BRT, Castellani was Executive Vice President of Tenneco Inc. and part of the senior management team that led the transformation of the ailing conglomerate into seven strong companies. He started his career at General Electric as an environmental scientist and strategic planner.

Castellani is frequently sought by the news media for his expert insights on business and was named one of the 100 most influential people in corporate governance by Directorship Magazine in 2007. A graduate of Union College in Schenectady, N.Y., Castellani now serves on its board of trustees. He is also an Ethics Resource Center Executive fellow and a member of the Advisory Council of the Business Roundtable Institute for Corporate Ethics, in addition to being a member of The Economic Club of Washington.

PhRMA represents America’s leading innovative biopharmaceutical research and biotechnology companies, which are devoted to discovering and developing medicines that enable patients to live longer, healthier, and more productive lives. Since 2000, PhRMA member companies have invested approximately $550 billion in the search for new treatments and cures, including an estimated $48.5 billion in 2012 alone.

For more information about PhRMA, visit

How can we nurture a system that properly values medicine?