What are the top most costly diseases for USA? The alignment of burden of illness with prevention and screening expenditures

doi:10.4236/health.2010.210172

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Vol.2, No.10, 1174-1178 (2010) Health

doi:10.4236/health.2010.210172

What are the top most costly diseases for USA? The

alignment of burden of illness with prevention and

screening expenditures

Guvenc Kockaya1*, Albert Wertheimer2

1Istanbul University, Istanbul Medical Faculty, Pharmacology and Clinical Pharmacology, Istanbul, Turkey; *Corresponding Author:

guvenckockay a@y ahoo.com

2Temple University, School of Pharmacy, Center for Pharmaceutical Health Services Research, Philadelphia, USA

Received 2 July 2010; revised 12 July 2010; accepted 20 July 2010.

ABSTRACT

Background: It was the intention of the authors

to generate a list of the top diseases respon-

sible for the greatest financial expense in the

United States. This listing would then inform

polic-ymakers as to the highest priority target

conditions. With such information available,

funding for the NIH could be accomplished bas-

ed upon factual criteria rather than political

clout or uninformed consensus. Method: The

first step was a literature review to explore arti-

cles and reports which were published about

the cost of illness (COI) up to December 2009.

Therefore the source of the data used in this

investigation was obtained from this retros-

pective search approach. Results: With refer-

ence to total cost for disease, first was HCVD

with 475.3 billion US dollars, followed by alcohol

abuse and substance at 300.6 billion US dollars,

digestive diseases at 259.6 billion US dollars,

cancer at 239.5 billion US dollars and mental

disease at 216,6 billion US dollars. Conclusion:

As has been seen, the total societal costs of the

diseases do not synch with the degree of atten-

tion paid to these various disease states. Sev-

eral of the diseases have very powerful and

vocal support organizations that encourage at-

tention and clinical research support. On the

other hand we hear very little about efforts

against allergic rhinitis or infectious and par-

asitic diseases.

Keywords: Cost of Illness; Burden of Illness

1. BACKGROUND AND INTRODUCTION

It is difficult to avoid seeing examples of promotional ca-

mpaigns encouraging women to self examine for poten-

tial breast cancer or advertisements for asthma, erectal

dysfunction, GERD or hypertension medications. In fact

during a typical day, many people are exposed to prom-

otional messages regarding prevention, screening and/or

treatment of a number of acute and chronic medical con-

ditions. Logically speaking, it would seem rational to de-

termine which diseases or medical conditions are the

most costly to the society and then focus our attention on

avoiding, treating or eliminating those medical conditi-

ons. But, in fact, as we know, the extent of advocacy ag-

ainst various problems is determined by a number of va-

riables which may include the political connections of

those involved, the fame or celebrity of a recent death

from a condition or the recent diagnosis in a Hollywood

star or famous athlete, or a whole host of other variables

which may or may not have any serious connection to

the priority of that particular disease state.

Apparently, upon the request of the US Senate, a stu-

dy was undertaken which was published by the National

Institutes of Health in the year 2000 where a large num-

ber of diseases were arrayed according to their total

burden of cost upon the US society [1]. A study of this

nature makes perfect sense since the Congress appropri-

ates funds to support the various institutes of the NIH.

Surely these legislators wanted to be certain that the

disease states they were funding research and education

for were the ones which should be tackled as a priority

in the United States.

Also a study was published by Bloom [2] in the year

2001. They searched 1725 published study reports which

included 80 different diseases from the year 1985 to

1999 and reported 17 different disease costs.

So it has been nearly 10 years since these studies were

conducted and many of the flaws and shortcomings of

the 2000 report may be corrected today given the far

greater extent of available data and knowledge.

However, every year the NIH publishes direct and in-

G. Kockaya et al. / Health 2 (2010) 1174-1178

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direct costs of 12 different main diseases categories [3].

There were not any published studies such as this one,

which includes 19 main diseases with some subgroups

resulting in a list of 32 different disease states. That ma-

kes this study unique.

1.1. The Study

It was the intention of the authors to generate a list of the

top diseases responsible for the greatest financial expe-

nse in the United States. This listing would then inform

policymakers as to the highest priority target conditions.

With such information available, funding for the NIH

could be accomplished based upon factual criteria rather

than political clout or uninformed consensus.

2. METHODOLOGY

The first step was a literature review to explore articles

and reports which were published about the cost of ill-

ness (COI) up to December 2009. Therefore the source

of the data used in this investigation was obtained from

this retrospective search approach. Also, it must be men-

tioned that there are a number of approaches for the cal-

culation of the cost of illness. Some of these approaches

are based on only direct costs and some are inclusive of

only indirect costs. Clabaugh and Ward [4] reported that

most COI studies included only one component.

The differences in data sources that influenced calcu-

lations were reported by them. We learned that the most

frequently used data sources were from insurance or

employer claims data and the second most commonly

used approach involved publicly available data sets from

the and NCHS or from the Agency for Healthcare Re-

search and Quality. Considering that there are very many

approaches, we defined the COI studies which would be

employed. In our definition, COI studies, reviews or

reports must include direct, indirect and total costs. We

did not evaluate the data source used in preparing the

COI numbers. Because of these limitations for the cal-

culation of COI, incomplete numbers were used from

various sources and matched together.

The first review included PubMed and the website for

each diseases Society. Also used were the websites of

the centers for disease control and prevention, and the

National Institutes of Health support for selected disea-

ses and conditions report. From these sources a listing of

55 different diseases was created. In the end we searched

8491 published documents. To be included it was deter-

mined that a study would have to adhere to the following

criteria:

● a defined US national population

● report published in English in a peer reviewed journal

● conclusion of cost of illness data between 1999 and

December 2009

● inclusion of the direct, indirect and total costs of

diseases

● inclusion of all diseases with costs higher than one

billion US dollars

● inclusion of the latest data.

Included only those studies which were intended to

shed light on the cost of illness question. Studies or re-

ports which included economic outcome data such as

cost-effectiveness or cost utility were ex-polluted. The

studies which did not include all of the direct, indirect

and total cost of diseases were also excluded and the

NIH 2000 numbers were employed if no data subsequent

to 1999 could be located.

In the end we listed 19 main diseases with some sub-

groups resulted in a list of 32 different disease states. All

costs were adjusted to 2009 US dollars by using a yearly

5% inflation rate factor to adjust up to 2009.

3. RESULTS

The list of cost of diseases may be seen in Table 1. We

found that depression is the most articles and published

journals about its cost of illness with 987 articles. De-

pression was followed by cancer (972), diabetes (747),

mental disease (559) and schizophrenia (419), next was

stroke with 410, asthma with 399, AIDS, 395, arthritis,

378 and tobacco/smoking related death and disease at

311 (Table 2).

Regarding only direct costs, the most costly disease was

heart and cardiovascular disease (HCVD) with 313.8

billion US dollars, it was followed by digestive diseases

at 220.8 billion US dollars, mental disease 175.7 billion

US dollars; nervous system diseases 153.3 billion US

dollars; diabetes 128,3 billion US dollars the complete

list is seen in Table 3.

Similarly, the most costly indirect expenses these dis-

eases was alcohol abuse and dependence 218.5 billion

US dollars; HCVD at 161.4 billion US dollars; cancer

141.5 billion US dollars; tobacco/smoking related death

and disease 101.85 billion US dollars and Alzheimer`s

disease 94 billion US dollars. The top five are seen in

Table 4.

With reference to total cost for disease, first was HC-

VD with 475.3 billion US dollars, followed by alcohol

abuse and substance at 300.6 billion US dollars, diges-

tive diseases at 259.6 billion US dollars, cancer at 239.5

billion US dollars and mental disease at 216,6 billion US

dollars the complete list is seen in Table 5.

4. CONCLUSIONS

As has been seen, the total societal costs of the diseases

G. Kockaya et al. / Health 2 (2010) 1174-1178

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Table 1. Estimated cost of illness of the USA in 2009 from highest to lowest total cost.

N Disease Direct Costsa Indirect Costa Total Costsa

1 Heart & CVD [5] 313.8 161.4 475.3

CHD [5]183 121.6 304.6

Hypertension [5]54.2 19.2 73.4

Stroke [5]45.9 23 68.9

2 Alcohol Abuse and Dependence [1] 82 218.5 300.6

3 Digestive Disease [6] 220.8 38.8 259.6

4 Cancer [7] 97.8 141.5 239.5

Breast Cancer [1]10.7 10 20.8

Cervical Cancer [7]5.5 0.6 6.1

5 Mental Disease [6] 175.7 40.9 216.6

Depression [8]40.4 88.4 128.9

Schzophrenia [9]31.9 45.5 88.2

6 Tobacco(smoking)-related Death and Disease [10] 100.8 101.8 202.6

7 Diabetes [11] 127.8 63.9 191.8

8 Lung Diseases [6] 113.6 63.8 177.4

Chronic Obstructive Pulmonary Disease [12]27.8 33.1 49.5

Asthma [12]14.6 5.8 20.5

9 Diseases of the Nervous System [6] 153.3 23.7 177

Parkinson`s Disease [13]9.7 22.6 32.3

Migraine [14]1.6 21.1 22.8

Epilepsy [15]9.5 0.1 9.6

10 Rheumotoid Artritis [16] 108.6 62.9 171.2

11 Alzheimer [3] 54 94 148

12 Arthritis [1] 24.7 80.7 105.5

13 Infectious and Parasitic Diseases [6] 44 41.3 85.3

14 Over Active Bladder [17] 22.3 33.5 55.8

15 Viral Respiratory Tract Infections (non influenza) [18] 22.7 30.1 53.6

16 AIDS [19] 9.4 41.7 51.2

17 Influenza [20] 11.4 17.9 40.4

18 Alergic Rhinitis [21] 7.3 6.1 13.5

19 Sexual Transmitted Disease [22] 9.1 0.9 10

aUS Dollars in billions & numbers are rounded

Table 2. The list of top 10 most cost-of illness published articles.

Diseases Article Numbers

Depression 987

Cancer 972

Diabetes 747

Mental Diseases 559

Schizophrenia 419

Stroke 410

Asthma 399

AIDS 395

Arthritis 378

Tobacco (Smoking)-Related Death and Disease 311

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Table 3. The list of top 5 most direct costly diseases.

Diseases Direct Costs (in billion US

dollars)

Heart & CVD 313.8

Digestive Diseases 220.8

Mental Diseases 175.7

Diseases of the Nervous System 153.3

Diabetes 128.3

Table 4. The list of top 5 most indirect costly diseases.

Diseases Direct Costs

(in billion US dollars)

Alcohol Abuse and Dependence 218.5

Heart & CVD 161.4

Cancer 141.5

Tobacco(Smoking)-Related

Death and Disease 101.85

Alzheimer 94

Table 5. The list of top 5 most total cost diseases.

Diseases Direct Costs

(in billion US dollars)

Heart & CVD 475.3

Alcohol Abuse and Dependence 300.6

Digestive Diseases 259.6

Cancer 239.5

Mental Diseases 216.6

do not synch with the degree of attention paid to these

various disease states. Several of the diseases have very

powerful and vocal support organizations that encourage

attention and clinical research support.

On the other hand we hear very little about efforts ag-

ainst allergic rhinitis or infectious and parasitic diseases.

In this study we learned that the most serious, fatal or te-

rminal conditions are not always the ones most detrim-

ental to the national economy. Probably more days are

lost from work for diseases such as low back pain the

common cold, seasonal flu, among others. Some of these

so-called trivial or limited conditions may have serious

economic consequences and therefore should not be

automatically dismissed.

However, depression has the most articles found in our

search, and its total cost is US$128.9 billion. This cost

gives it a place in the middle of the total cost list. Also it

is the same as AIDS, which is in the lower end of the

cost list, but it is on the top of the published article list.

Same explanation is in order for breast cancer and cer-

vical cancer, as well. However much is said about taking

action for breast or cervical cancer, yet direct, indirect

and total costs for them are not as high for the society as

chronic obstructive pulmonary disease (COPD) or as

attention deficit hyperactivity disorder (ADHD) which

were not even mentioned as much as breast cancer or

cervical cancer.

On the other hand, alcohol abuse & dependence and

digestive diseases are in the top of the cost list. But, in so-

ciety they are rarely spoken about as much as other dis-

eases. Also they aren’t in the top of the articles list. Be-

cause of its high costs, there is much publicity about

prevention of digestive diseases and awareness projects

about food safety or washing hands. For alcohol abuse &

dependence, there are projects about decreasing alcohol

consumption like increasing the tax on alcohol or hold-

ing seminars in schools about alcohol abuse & depend-

ence, for creating public awareness.

Our study also shows that the best matched diseases

are Heart & CVD, Cancer and Mental Diseases. They

are in the top of the cost list and in the top of article list.

Also \frequently, we can see a project on television, in

newspapers or journals for increasing public awareness.

Because if we can increase awareness of an illness,

people may care about it and they may go to their physi-

cian regarding their signs and symptoms and be more

compliant with their treatment. All of this may decreases

the cost of illness to the reimbursement companies and

to society.

By following our study findings, it could said that we

need to care more about alcohol or tobacco dependence,

digestive diseases such as heart and CVD, cancer or

mental diseases.

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