An Unhealthy America: The Economic Burden of ... - Milken Institute

An Unhealthy AmericaMilken InstituteMENTAL DISORDERSIn a given year, approximately 26.2 percent of Americans over age 18 suffer from one or more mental conditions,including major depression, mild depression, bipolar disorder, or various anxiety disorders, such as panic, obsessivecompulsivedisorder, and phobias. Even though mental disorders are widespread, only 6 percent, or one person in 17,suffer from serious mental illness. All these diseases are a significant source of disability annually. 62Treatment costs consist primarily of prescription medications and, to a lesser extent, professional services. In 2003,professional services (principally, physicians and therapists) accounted for only 27 percent of spending on mentaldisorders. Prescription drugs accounted for approximately 40 percent. Clearly, therapeutic drugs play a crucial role ittreating these diseases, and new medications are expected to have a profound impact on treatment costs.Age Demographics OnlyMental disorders do not appear to be diseases of the aging process. For example, the median age at onset formajor depression is thirty-two, while the median age at onset of bipolar disorder is twenty-five. However, fromonset, these diseases tend to affect patients for long periods, in many instances for the rest of their lives. Thus,aging trends will affect prevalence rates and PRC. We hold age-specific prevalence rates at their 2003 levelsand find that prevalence increases from 10.4 percent of the adult population in 2003 to 13.9 percent in 2023. Theaging of the population alone will increase PRC by 17.5 million, an increase of 57.7 percent over PRC of 30.3million in 2003.Baseline ScenarioExcessive alcohol consumption, as measured by adults “at risk” of consuming more than two drinks per day, isexpected to remain unchanged at the 2003 level of 5.8 percent of the adult population. Other behavioralfactors, such as illicit drug use and stress, are expected to contribute to rising prevalence. By 2023, prevalencewill be found in approximately 14.3 percent of the adult population. By then, PRC will total roughly 46.7 million,or 53.8 percent more than in 2003.Based upon the projections on medical care cost growth, expenditures per PRC increase from $1,509 in 2003to $2,862 in 2023, or by approximately 89.7 percent. Surprisingly, treatment costs exhibit the third-highestgrowth rate among the chronic diseases in this study, after prostate cancer treatment spending (90.8 percent)and “other cancers” (92.5 percent). Total treatment expenditures grow from $45.8 billion to $135.2 billion, anincrease of 195.3 percent. The nation will spend roughly $1.5 trillion cumulatively over the next twenty years intreatment costs.Optimistic ScenarioWhile the origins of most mental disorders are complex and may have a hereditary or environmentalcomponent, behavioral factors can also affect the prevalence and severity of these conditions. The proportionof the population “at risk” of excessive alcohol consumption no longer remains constant but declines by 1.6percentage points by 2023. This behavioral change lowers PRC prevalence by approximately 5.8 million.Even so, the prevalence rate will rise throughout the projection period, reaching 11.9 percent of the population62. http://www.nimh.nih.gov/healthinformation/statisticsmenu.cfm.[ 113 ]