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

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An Unhealthy AmericaMilken InstituteFemale Breast Cancer Female Patients Breast - Invasive Cancer Treatment Patients DistributionsInvasive Treatment DistributionsPercent70Expenditures PRC* Expenditures/PRCNo SurgeryDisease(Billions) Breast-Conserving (Millions) Surgery (Thousands)60Cancer 48.1 Breast-Conserving 10.6 Surgery w/Radiation 4.5Breast Cancer 50Mastectomy5.5 1.1 4.8Colon Cancer 3.9 0.3 11.5Lung Cancer 406.3 0.4 17.1Prostate Cancer 4.3 1.0 4.130Other Cancers 28.0 7.7 3.6Pulmonary 20Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.0Hypertension 10History32.5 36.8 0.9ForecastHeart Disease 64.7 19.2 3.40Stroke 1993 1998 2003 13.620082013 2.4 2018 2023 5.6Sources: National Cancer Institute, Millken InstituteMental Disorders 45.8 30.3 1.5Total 277.0 162.2 1.7Still for breast cancer, PRC: we Population next want Reporting to calculate Condition the indirect impact ratio of presenteeism to lost workdays. We assumeit is affected by all four treatment options. However, we also assume that certain treatments will have a greater effect onpresenteeism: (1) no surgery (highest); (2) BCS with radiation; (3) mastectomy; and (4) BCS without radiation (lowest).We cannot be sure about the magnitude of variations in the first three categories so give them equal weights (0.3 each)and 0.1 for treatment option (4), BCS without radiation. We deflate the 2003 baseline presenteeism to lost workdaysimpact ratio by the weighted index. 85 The following table shows the ratio of presenteeism to lost workdays for cancer.CancerCancer - Presenteeism to Lost WorkdaysPresenteeism to Lost WorkdaysPresenteeism / AbsoluteExpenditures PRC* Expenditures/PRCYear Lost Workdays ChangeDisease(Billions) (Millions) (Thousands)2003 16.95 –Cancer 48.1 10.6 4.52004 16.64 -0.308Breast Cancer 5.5 1.1 4.82005 16.30 -0.343Colon Cancer 3.9 0.3 11.52006 15.95 -0.343Lung Cancer2007 15.626.3 0.4-0.34017.1Prostate Cancer 2008 15.33 4.3 1.0 -0.2844.1Other Cancers 2009 15.04 28.0 7.7 -0.2943.6Pulmonary Conditions 2010 14.86 45.2 49.2 -0.1770.9Diabetes 2011 14.63 27.1 13.7 -0.2292.0Hypertension 2012 14.46 32.5 36.8 -0.1660.9Heart Disease 2013 14.30 64.7 19.2 -0.1693.4Stroke 2014 13.96 13.6 -0.333 2.4 5.6Mental Disorders 2015 13.76 45.8 30.3 -0.2041.5Total 2016 277.0 13.57 162.2 -0.1901.7PRC: Population Reporting 2017 Condition 13.39 -0.1822018 13.21 -0.1782019 13.03 -0.1792020 12.85 -0.1772021 12.67 -0.1822022 12.50 -0.1732023 12.33 -0.171Source: Milken Institute85. For each series, we use 2003 as base year.[ 141 ]
An Unhealthy AmericaMilken InstituteFor other chronic diseases, we follow a similar approach to project the indirect impact ratio through an ordinal ranking,by disease, and try to ascertain the relative effects of the range of treatment options on each. The rationale behind sucha ranking is partly borrowed from the number of ongoing clinical trials.The next table gives totals for ongoing clinical trials, as of early 2007. Cancer is the subject of the most trials. We assumethat more clinical trials will lead to less invasive treatment options and that EPRC totals will be greatly affected.Clinical Trials by DiseaseClinical Trials by DiseaseChronic ExpendituresDisease PRC* Total Expenditures/PRCDiseaseBreast Cancer (Billions) (Millions) 543 (Thousands)Cancer Colon Cancer48.1 10.6 3374.5Breast Cancer Lung Cancer 5.5 441 1.1 4.8Colon Cancer Prostate Cancer 3.9 257 0.3 11.5Lung Cancer Heart Disease* 6.3 1,532 0.4 17.1Prostate Cancer Diabetes 4.3 447 1.0 4.1Other Cancers Pulmonary Conditions 28.0 145 7.7 3.6Pulmonary ConditionsDepression 45.2 49.2 2970.9Diabetes * Including Hypertension 27.1 and Stroke 13.7 2.0Hypertension Source: ClinicalTrials.gov 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4Stroke 13.6 2.4 5.6We also assume thatMentalless invasiveDisorderstreatment options will45.8affect future presenteeism,30.3another1.5factor in building the ordinalTotal 277.0 162.2 1.7ranking. The concept is summarized in the following table:PRC: Population Reporting ConditionEffect of Invasive Treatments on Presenteeism by DiseaseEffect of Invasive Treatments on Presenteeism by DiseaseExpenditures PRC* Expenditures/PRCPercentDiseaseCancer(Billions) BCS*(without 48.1(Millions)10.6(Thousands) BCS*(with 4.5Comparedto CancerChronic Disease Breast Cancer No Surgery radiation) 5.5 Mastectomy 1.1 radiation) 4.8Cancer Colon Cancer X 3.9 X 0.3X 11.5 X 100Heart Disease Lung Cancer X 6.3 X 0.4X 17.1 60Diabetes Prostate Cancer X 4.3 X 1.0 4.1 35Stroke Other Cancers X 28.0 7.7 3.6 25Asthma Pulmonary Conditions X 45.2 49.2 0.9 20Emotional Disturbances Diabetes X 27.1 13.7 2.0 15Hypertension Hypertension X 32.5 36.8 0.9 10* Breast-Conserving Heart Surgery DiseaseSource: Milken Stroke Institute64.713.619.22.43.45.6Mental Disorders 45.8 30.3 1.5Total 277.0 162.2 1.7PRC: Population Reporting Condition[ 142 ]
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