The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992

Aims, design and setting. The economic costs of alcohol, tobacco and illicit drugs to Canadian society in 1992 are estimated utilizing a cost-of-illness framework and recently developed international guidelines. Measurements. For causes of disease or death (using ICD-9 categories), pooled relative risk estimates from meta-analyses are combined with prevalence data by age, gender and province to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations are used to calculate associated health care, law enforcement, productivity and other costs. The results are compared with other studies, and sensitivity analyses are conducted on alternative measures of alcohol consumption, alternative discount rates for productivity costs and the use of diagnostic-specific hospitalization costs. Findings. The misuse of alcohol, tobacco and illicit drugs cost more than $18.4 billion in Canada in 1992, representing $649 per capita or 2.7% of GDP. Alcohol accounts for approximately $7.52 billion in costs, including $4.14 billion for lost productivity, $1.36 billion for law enforcement and $1.30 billion in direct health care costs. Tobacco accounts for approximately $9.56 billion in costs, including $6.82 billion for lost productivity and $2.68 billion for direct health care costs. The economic costs of illicit drugs are estimated at $1.4 billion. Conclusions. Substance abuse exacts a considerable toll to Canadian society in terms of illness, injury, death and economic costs.     

The links between alcohol, crime and the criminal justice system: explanations, evidence and interventions.

Many studies indicate that alcohol abuse and dependence are closely linked with the criminal justice system (CJS). Alcohol was consumed prior to about half of all homicides and assaults, and nearly 40 percent of state prisoners report committing their current offense under the influence of alcohol. Alcohol abuse cost approximately $13 billion in 1992 non-health related costs. This article seeks to address this burden on the CJS and society. It presents a conceptual framework for explaining the alcohol-crime nexus, reviews empirical evidence of the complex associations between alcohol consumption and crime, and links these with promising intervention strategies to reduce alcohol-related crime.     

Medical Expenditures and Earnings Losses Among US Adults With Arthritis in 2013

Objective

We estimated the economic impact of arthritis using 2013 US Medical Expenditure Panel Survey (MEPS) data.

Methods

We calculated arthritis‐attributable and all‐cause medical expenditures for adults age ≥18 years and arthritis‐attributable earnings losses among those ages 18–64 years who had ever worked. We calculated arthritis‐attributable costs using multistage regression‐based methods, and conducted sensitivity analyses to estimate costs for 2 other arthritis definitions in MEPS.

Results

In 2013, estimated total national arthritis‐attributable medical expenditures were $139.8 billion (range $135.9–$157.5 billion). Across expenditure categories, ambulatory care expenditures accounted for nearly half of arthritis‐attributable expenditures. All‐cause expenditures among adults with arthritis represented 50% of the $1.2 trillion national medical expenditures among all US adults in MEPS. Estimated total national arthritis‐attributable earning losses were $163.7 billion (range $163.7–$170.0 billion). The percentage with arthritis who worked in the past year was 7.2 percentage points lower than those without arthritis (76.8% [95% confidence interval (95% CI)] 75.0–78.6 and 84.0% [95% CI 82.5–85.5], respectively, adjusted for sociodemographics and chronic conditions). Total arthritis‐attributable medical expenditures and earnings losses were $303.5 billion (range $303.5–$326.9 billion).

Conclusion

Total national arthritis‐attributable medical care expenditures and earnings losses among adults with arthritis were $303.5 billion in 2013. High arthritis‐attributable medical expenditures might be reduced by greater efforts to reduce pain and improve function. The high earnings losses were largely attributable to the substantially lower prevalence of working among those with arthritis compared to those without, signaling the need for interventions that keep people with arthritis in the workforce.     

A Reevaluation of the Costs of Heart Failure and Its Implications for Allocation of Health Resources in the United States

The annual cost of heart failure (HF) is estimated at $39.2 billion. This has been acknowledged to underestimate the true costs for care. The objective of this analysis is to more accurately assess these costs. Publicly available data sources were used. Cost calculations incorporated relevant factors such as Medicare hospital cost‐to‐charge ratios, reimbursement from both government and private insurance, and out‐of‐pocket expenditures. A recently published Atherosclerosis Risk in Communities (ARIC) HF scheme was used to adjust the HF classification scheme. Costs were calculated with HF as the primary diagnosis (HF in isolation, or HFI) or HF as one of the diagnoses/part of a disease milieu (HF syndrome, or HFS). Total direct costs for HF were calculated at $60.2 billion (HFI) and $115.4 billion (HFS). Indirect costs were $10.6 billion for both. Costs attributable to HF may represent a much larger burden to US health care than what is commonly referenced. These revised and increased costs have implications for policy makers.     

Direct medical cost of overweight and obesity in the USA: a quantitative systematic review

To estimate per‐person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. PubMed (1968–2009), EconLit (1969–2009) and Business Source Premier (1995–2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. A total of 33 US studies met review criteria. Among the four highest‐quality studies, the 2008 per‐person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimates included use of national samples vs. more selected populations, age groups examined, inclusion of all medical costs vs. obesity‐related costs only, and body mass index cut‐offs for defining overweight and obesity. Depending on the source of total national healthcare expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of US healthcare spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs and use standard body mass index cut‐offs.     

The Burden of Disease and the Cost of Illness Attributable to Alcohol Drinking—Results of a National Study

Background and Aims: The World Health Organization estimated that 3.2% of the burden of disease around the world is attributable to the consumption of alcohol. The aim of this study is to estimate the burden of disease attributable to alcohol consumption in Portugal. Methods: Burden and costs of diseases attributable to alcohol drinking were estimated based on demographic and health statistics available for 2005, using the Disability‐Adjusted Life Years (DALY) lost generated by death or disability. Results: In Portugal, 3.8% of deaths are attributable to alcohol (4,059 of 107,839). After measuring the DALY generated by mortality data, the proportion of disease attributable to alcohol was 5.0%, with men having 5.6% of deaths and 6.2% of disease burden, while female figures were, respectively, 1.8 and 2.4%. Considering the sum of death and disability DALYs, liver diseases represented the main source of the burden attributable to alcohol with 31.5% of total DALYs, followed by traffic accidents (28.2%) and several types of cancer (19.2%). As for the cost of illness incurred by the health system, our results indicate that €95.1 millions are attributable to alcohol‐related disease admissions (liver diseases, cancer, traffic accidents, and external causes) while the ambulatory costs of alcohol‐related diseases were estimated in €95.9 million, totaling €191.0 million direct costs, representing 0.13% of Gross Domestic Product and 1.25% of total national health expenditures. An alternative analysis was carried out using higher consumption levels so as to replicate aggregate alcohol consumption statistics. In this case, DALYs lost increased by 11.7% and health costs by 23%. Conclusion: Our results confirm that alcohol is an important health risk factor in Portugal and a heavy economic burden for the health system, with hepatic diseases ranking first as a source of burden of disease attributable to alcohol.     

Cost‐Effectiveness of Implanted Defibrillators in Young People with Inherited Cardiac Arrhythmias

Background: The implanted cardioverter‐defibrillator (ICD) has been shown to improve survival in adult patients with high risk acquired cardiac disease, with a cost‐effectiveness ratio in the range of $30,000 to $185,000 per quality‐adjusted‐life‐year saved. However, data on the benefit and cost‐effectiveness of device therapy in high‐risk patients with inherited cardiac disorders are limited. Methods: We developed two separate computer‐based analytical models to compare non‐ICD with ICD therapy in patients (age range: 10–75 years) with long QT syndrome (LQTS) and hypertrophic cardiomyopathy (HCM). In each disease entity patients were stratified into low‐risk (no known risk factors); high‐risk (known risk factors [primary prevention]); and very high‐risk (prior near‐fatal events [secondary prevention]). Net costs were defined as the difference between costs resulting from treatment of the disease and savings due to gained productivity attributable to prevention of sudden cardiac death. Outcome was defined as costs per quality‐adjusted life‐years saved. Results: In LQTS, defibrillator therapy was shown to be cost effective in high‐risk male patients (incremental cost‐effectiveness ratio [ICER]=$3328 per quality‐adjusted‐life‐year saved), and cost saving in high‐risk females (ICER =$7102 gained per quality‐adjusted‐life‐year saved) and very high‐risk males and females (ICER =$15,483 and 19,393 gained per quality‐adjusted‐life‐year saved, respectively). In HCM, defibrillator therapy was cost saving in both male and female high‐risk (ICER =$17,892 and $17,526 gained per quality‐adjusted‐life‐year saved, respectively) and very high‐risk (ICER =$22,944 and $22,329 gained per quality‐adjusted‐life‐year saved, respectively) patients. Defibrillator therapy was not shown to be cost effective in low‐risk patients with either LQTS or HCM (ICER in the range of $400,000 to $600,000 lost per quality‐adjusted‐life‐year saved). Sensitivity analyses were consistent with the results in each risk group. Conclusions: In appropriately selected patients with inherited cardiac disorders, early intervention with ICD therapy is cost‐effective to cost saving due to added years of gained productivity when the lifespan of an individual at risk is considered.     

Estimating hip fracture morbidity,mortality and costs

OBJECTIVES: To estimate lifetime morbidity, mortality, and costs from hip fracture incorporating the effect of deficits in activities of daily living. DESIGN: Markov computer cohort simulation considering short- and long-term outcomes attributable to hip fractures. Data estimates were based on published literature, and costs were based primarily on Medicare reimbursement rates. SETTING: Postacute hospital facility. PARTICIPANTS: Eighty-year-old community dwellers with hip fractures. MEASUREMENTS: Life expectancy, nursing facility days, and costs. RESULTS: Hip fracture reduced life expectancy by 1.8 years or 25% compared with an age- and sex-matched general population. About 17% of remaining life was spent in a nursing facility. The lifetime attributable cost of hip fracture was $81,300, of which nearly half (44%) related to nursing facility expenses. The development of deficits in ADLs after hip fracture resulted in substantial morbidity, mortality, and costs. CONCLUSION: Hip fractures result in significant mortality, morbidity, and costs. The estimated lifetime cost for all hip fractures in the United States in 1997 likely exceeded $20 billion. These results emphasize the importance of current and future interventions to decrease the incidence of hip fracture.     

Medical cost of type 2 diabetes attributable to physical inactivity in the United States in 2012

Aims

Type 2 diabetes has grown to epidemic proportions in the U.S. and physical activity levels in the population continues to remain low, although it is one of the primary preventive strategies for diabetes. The objectives of this study were to estimate the direct medical costs of type 2 diabetes attributable to not meeting physical activity Guidelines and to physical inactivity in the U.S. in 2012.

The healthcare costs of sarcopenia in the United States

OBJECTIVES: To estimate the healthcare costs of sarcopenia in the United States and to examine the effect that a reduced sarcopenia prevalence would have on healthcare expenditures. DESIGN: Cross-sectional surveys. SETTING: Nationally representative surveys using data from the U.S. Census, Third National Health and Nutrition Examination Survey, and National Medical Care and Utilization Expenditure Survey. PARTICIPANTS: Representative samples of U.S. adults aged 60 and older. MEASUREMENTS: The healthcare costs of sarcopenia were estimated based on the effect of sarcopenia on increasing physical disability risk in older persons. In the first step, the healthcare cost of disability in older Americans was estimated from national surveys. In the second step, the proportion of the disability cost due to sarcopenia (population-attributable risk) was calculated to determine the healthcare costs of sarcopenia. These calculations relied upon previously published relative risk values for disability in sarcopenic individuals and sarcopenia prevalence rates in the older population. RESULTS: The estimated direct healthcare cost attributable to sarcopenia in the United States in 2000 was $18.5 billion ($10.8 billion in men, $7.7 billion in women), which represented about 1.5% of total healthcare expenditures for that year. A sensitivity analysis indicated that the costs could be as low as $11.8 billion and as high as $26.2 billion. The excess healthcare expenditures were $860 for every sarcopenic man and $933 for every sarcopenic woman. A 10% reduction in sarcopenia prevalence would result in savings of $1.1 billion (dollars adjusted to 2000 rate) per year in U.S. healthcare costs. CONCLUSION: Sarcopenia imposes a significant but modifiable economic burden on government-reimbursed healthcare services in the United States. Because the number of older Americans is increasing, the economic costs of sarcopenia will escalate unless effective public health campaigns aimed at reducing the occurrence of sarcopenia are implemented.     

Economic evaluation of the societal costs of hepatitis B in South Korea

BACKGROUND AND AIMS: Hepatitis B (HBV) infection remains a major public health problem in South Korea, and accounts for considerable morbidity and mortality. At present, very little is known about the cost of HBV to the South Korean health-care system and society. The present study was therefore conducted to estimate the total annual cost of HBV infection in South Korea for a given year (1997). METHODS: The study was conducted from the South Korean societal perspective, taking into account the direct and indirect costs of HBV vaccination programs (prevention costs), and those related to the treatment of acute and chronic hepatitis, cirrhosis and liver cancer (disease costs). Several assumptions were made in arriving to actual cost estimates. RESULTS: The total societal cost of HBV in 1997 was 1078.3 billion Won ($US 959.7 million), 142.3 billion Won or 13.2% being attributable to prevention costs and 225.4 billion Won or 20.9% being attributable to indirect costs of HBV-related diseases. The total cost (direct plus indirect) associated with HBV-related diseases to the South Korean society was 936.1 billion Won ($US 833.1 million), of which 45.3% was attributable to cirrhosis-related costs. In terms of disease-related direct costs alone (710.5 billion Won or $US 632.3 million), the estimated annual spending per patient was 1.37 million Won ($US 1219). The direct costs of the HBV disease (prevention and disease treatment, amounting to 782.2 billion Won or $US 696.2 million) is equivalent to 3.2% of the national health-care expenditure for 1997. CONCLUSIONS: This study confirms that HBV is a significant cost burden to the South Korean society, and in the absence of an effective cure reinforces the importance of continued disease prevention via vaccination.     

The Economic Cost of Alcohol-related Health Care in New Zealand

This paper estimates the economic cost of the extra health care in New Zealand associated with the misuse of alcohol. From a range of different studies it was estimated that 7.8% of hospital operating costs were attributable to alcohol consumption. These additional costs formed 85.5% of the total increase in health costs related to excess alcohol consumption. The estimate of this total, NZ$108.3m., represented 0.4% of New Zealand GNP for 1981–82.     

Direct medical costs of syncope-related hospitalizations in the United States

Little is known about the costs of syncope-related admissions in the United States. A nationally representative sample of hospital discharges and reported charges was analyzed, and costs were estimated using Medicare cost-to-charge ratios. A conservative estimate of total annual costs for syncope-related hospitalizations was $2.4 billion (95% confidence interval [CI] $2.2 to $2.6 billion), with a mean cost of $5,400 (95% CI $5,100 to $5,600) per hospitalization. Efforts to safely decrease syncope-related admissions may result in substantial costs savings.     

Costs of occupational COPD and asthma.

OBJECTIVE: To estimate the number of annual deaths, as well as the direct and indirect costs of occupational COPD and asthma, in the United States in 1996. DESIGN: Aggregation and analysis of national data sets collected by the National Center for Health Statistics, the Health Care Financing Administration, and other government bureaus and private firms. To assess mortality, we reviewed data from national surveys and applied a population attributable risk (PAR) of 15% for both asthma and COPD. We use a lower age limit of 35 years for occupational COPD and 20 years for occupational asthma. To calculate costs, we use the human capital method that decomposes costs into direct categories, such as medical expenses, as well as indirect categories, such as lost earnings and lost home production. We calculated proportionately adjusted costs for other plausible PARs. RESULTS: The 15% PARs result in costs of $5.0 billion for COPD and $1.6 billion for asthma. For COPD, 56% of costs were direct and 44% were indirect; for asthma, 74% were direct and 26% indirect. These estimates are conservative since we ignored costs associated with pain and suffering as well as the value of care rendered by family members. The proportionately adjusted costs for 10 to 20% PARs are $3.3 to $6.6 billion for COPD and $1.1 to $2.1 billion for asthma. CONCLUSIONS: The estimated $6.6 billion cost of occupational COPD and asthma in 1996 is likely to rise with the increasing prevalence of these diseases and warrants preventive intervention.     

The annual global economic burden of heart failure

Background

Heart failure (HF) imposes both direct costs to healthcare systems and indirect costs to society through morbidity, unpaid care costs, premature mortality and lost productivity. The global economic burden of HF is not known.

Methods

We estimated the overall cost of heart failure in 2012, in both direct and indirect terms, across the globe. Existing country-specific heart failure costs analyses were expressed as a proportion of gross domestic product and total healthcare spend. Using World Bank data, these proportional values were used to interpolate the economic cost of HF for countries of the world where no published data exists. Countries were categorized according to their level of economic development to investigate global patterns of spending.

Results

197 countries were included in the analysis, covering 98.7% of the world's population. The overall economic cost of HF in 2012 was estimated at $108 billion per annum. Direct costs accounted for ~ 60% ($65 billion) and indirect costs accounted for ~ 40% ($43 billion) of the overall spend. Heart failure spending varied widely between high-income and middle and low-income countries. High-income countries spend a greater proportion on direct costs: a pattern reversed for middle and low-income countries.

Conclusions

Heart failure imposes a huge economic burden, estimated at $108 billion per annum. With an aging, rapidly expanding and industrializing global population this value will continue to rise.     

The burden of selected digestive diseases in the United States

BACKGROUND & AIMS: Gastrointestinal (GI) and liver diseases inflict a heavy economic burden. Although the burden is considerable, current and accessible information on the prevalence, morbidity, and cost is sparse. This study was undertaken to estimate the economic burden of GI and liver disease in the United States for use by policy makers, health care providers, and the public. METHODS: Data were extracted from a number of publicly available and proprietary national databases to determine the prevalence, direct costs, and indirect costs for 17 selected GI and liver diseases. Indirect cost calculations were purposefully very conservative. These costs were compared with National Institutes of Health (NIH) research expenditures for selected GI and liver diseases. RESULTS: The most prevalent diseases were non-food-borne gastroenteritis (135 million cases/year), food-borne illness (76 million), gastroesophageal reflux disease (GERD; 19 million), and irritable bowel syndrome (IBS; 15 million). The disease with the highest annual direct costs in the United States was GERD ($9.3 billion), followed by gallbladder disease ($5.8 billion), colorectal cancer ($4.8 billion), and peptic ulcer disease ($3.1 billion). The estimated direct costs for these 17 diseases in 1998 dollars were $36.0 billion, with estimated indirect costs of $22.8 billion. The estimated direct costs for all digestive diseases were $85.5 billion. Total NIH research expenditures were $676 million in 2000. CONCLUSIONS: GI and liver diseases exact heavy economic and social costs in the United States. Understanding the prevalence and costs of these diseases is important to help set priorities to reduce the burden of illness.     

State-level medical and absenteeism cost of asthma in the United States

Objective: For medically treated asthma, we estimated prevalence, medical and absenteeism costs, and projected medical costs from 2015 to 2020 for the entire population and separately for children in the 50 US states and District of Columbia (DC) using the most recently available data. Methods: We used multiple data sources, including the Medical Expenditure Panel Survey, U.S. Census Bureau, Kaiser Family Foundation, Medical Statistical Information System, and Current Population Survey. We used a two-part regression model to estimate annual medical costs of asthma and a negative binomial model to estimate annual school and work days missed due to asthma. Results: Per capita medical costs of asthma ranged from $1,860 (Mississippi) to $2,514 (Michigan). Total medical costs of asthma ranged from $60.7 million (Wyoming) to $3.4 billion (California). Medicaid costs ranged from $4.1 million (Wyoming) to $566.8 million (California), Medicare from $5.9 million (DC) to $446.6 million (California), and costs paid by private insurers ranged from $27.2 million (DC) to $1.4 billion (California). Total annual school and work days lost due to asthma ranged from 22.4 thousand (Wyoming) to 1.5 million days (California) and absenteeism costs ranged from $4.4 million (Wyoming) to $345 million (California). Projected increase in medical costs from 2015 to 2020 ranged from 9% (DC) to 34% (Arizona). Conclusion: Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks.     

The economic burden of mental health problems in Canada

This study provides a comprehensive estimate of the economic burden of mental health problems in Canada in 1998. In particular, it estimates the cost of non-medical services that have not been previously published and the value of short-term disability associated with mental health problems that were previously underestimated according to the definitions used here. The costs of consultations with psychologists and social workers not covered by public health insurance was $278 million, while the value of reduced productivity associated with depression and distress over the short term was $6 billion. Several data limitations suggest that these are underestimates. The estimated total burden of $14.4 billion places mental health problems among the costliest conditions in Canada.     

The economic burden of hypertension in rural south‐west China

Objective To estimate the economic burden of hypertension in a given year in rural Yunnan Province of China, including direct, indirect and intangible costs. Methods A prevalence‐based cost‐of‐illness method was used to estimate the economic burden of hypertension. Data on participants’ demographic characteristics, inpatient hospitalisation expenditures, outpatient visit expenditures, self‐medication costs and indirect costs related to hypertension were collected from a cross‐sectional health examination and questionnaire survey, involving 9396 consenting individuals aged ≥18 years and 3500 households. Blood pressure (BP) levels were determined from the average of three BP measurements. Years of life lost (YLL) because of hypertension was estimated using medical death certificates. Results The overall prevalence of and YLL/1000 population because of hypertension was 24.8% and 1.5 years for the survey population, respectively. Mean unit direct medical costs, direct non‐medical costs, morbidity costs, mortality costs, intangible costs and cost of illness were estimated to be $467.2, $20.1, $23.5, $8265.1, $417.4 and $9393.3, respectively. The total cost of hypertension was estimated to be $231.7 million. Direct costs represented the largest component of economic cost of hypertension. On average, males had higher overall direct, indirect and intangible costs of hypertension than females. Both indirect and intangible costs decreased with age, whereas direct costs increased with age. The incidence of household catastrophic health payment and household impoverishment because of hypertension was 8.9% and 4.1%, respectively. Conclusions Hypertension inflicts a considerable economic burden upon individual households and society as a whole in Yunnan Province, China.     

Alcohol Use and Breast Cancer: A Critical Review

The objective of this study was to outline the biological pathways of alcohol‐attributable breast cancer, the epidemiological risk relationship between alcohol consumption and breast cancer, and the global burden of breast cancer incidence and mortality attributable to alcohol consumption, with a focus on light drinking. First, the literature regarding the biological mechanisms of how alcohol affects the risk of breast cancer was reviewed and summarized. Second, a search of meta‐analyses that evaluated the risk relationship between alcohol consumption and breast cancer was conducted. Last, the burden of alcohol‐attributable breast cancer incidence and mortality was estimated by means of a Population‐Attributable Fraction methodology. Data on alcohol consumption were obtained from the Global Information System on Alcohol and Health, and data on cancer incidence and mortality were obtained from the GLOBOCAN database. Alcohol consumption affects breast cancer risk through the alteration in hormone levels and the associated biological pathways, the metabolism of ethanol resulting in carcinogens, and the inhibition of the one carbon metabolism pathway. The systematic review found 15 meta‐analyses on the risk relationship between alcohol consumption (also light consumption) and the risk of breast cancer. All but 2 of these analyses showed a dose–response relationship between alcohol consumption and the risk of breast cancer. An estimated 144,000 (95% confidence interval [CI]: 88,000 to 200,000) breast cancer cases and 38,000 (95% CI: 2,400 to 53,000) breast cancer deaths globally in 2012 were attributable to alcohol, with 18.8% of these cases and 17.5% of these deaths affecting women who were light alcohol consumers. All levels of evidence showed a risk relationship between alcohol consumption and the risk of breast cancer, even at low levels of consumption. Due to this strong relationship, and to the amount of alcohol consumed globally, the incidence of and mortality from alcohol‐attributable breast cancer is large.