title: Gender effects on health care costs in cardiovascular medicine-a black box?
abstract: BACKGROUND
  Gender differences were documented for several diseases. This might influence treatment costs for the insurance companies as well as reimbursement of the health care facilities. This manuscript deals with the possible economic implications of gender-related differences in cardiovascular medicine.
  
  
  METHODS
  A systematical review of the literature reporting the impact of gender on health care costs with special focus on cardiovascular medicine.
  
  
  RESULTS
  Women cause higher health care costs during their lifetime, but large part of the difference compared with men is caused by pregnancy and birth, not by diseases. However, after subtracting the costs for pregnancy and birth, there still remains a difference with higher costs for women, although the origin of this disparity is not definitely clear up to date. In cardiovascular medicine, especially the risk factor metabolic syndrome including diabetes had a higher prevalence in women and was shown to have a greater impact on cardiovascular disease compared with men. This concerned both costs and outcome. But in contrast to this, women experienced poorer preventive treatment of their metabolic syndrome, especially with regards to lipid levels. This influenced the costs of hospital treatment as well as the prognosis, for example, following coronary bypass grafting.
  
  
  CONCLUSIONS
  The higher influence of several risk factors on cardiovascular disease in women should lead to improved preventive strategies in female patients. Further research is necessary to give more evidence for gender-related differences within the impact of several risk factors on treatment costs. This could then also influence reimbursement strategies taking these gender disparities into account.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany. h.gulbins@uke.de
authors.forename: Helmut
authors.initials: H
authors.lastname: Gulbins
authors.forename: Beatrice
authors.initials: B
authors.lastname: Vogel
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008297:Male; D008427:Maternal Health Services / Q000191:economics; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D014932:Women's Health Services / Q000191:economics*