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

An Unhealthy AmericaMilken InstituteA. Disease Trends and Direct Costs: National LevelNumerous factors have shaped health trends over the past two decades. On the positive side, improvements in diagnosisand treatments have helped flatten and, in some cases, roll back disease rates. The benefits of lifestyle changes, such assmoking cessation and improved diet, are also showing up in disease trends. Countering these factors, the aging babyboom population is pushing up health-care costs and straining the health-care system. Meanwhile, as more Americansmove to cities, health problems associated with urbanization are on the rise.Many of the trends in the data have actually been discernable even beyond the scope observed in the MEPS data.According to the National Center for Health Statistics, for example, the prevalence 2 rate of cardiovascular disease rosefrom 64.7 per 1,000 people in 1970 to 99.3 per 1,000 people in 1990, a 53.4 percent increase. During the same period,overall cancer incidence rates rose from 11.1 per 1,000 people to 18.7 per 1,000, an increase of 68.5 percent. 3Key Differences in Direct Costs from Other StudiesDirect Costs (US$ (US$ Billions) Billions)Chronic Disease Disease Milken Study Study Other Studies Studies Source of of Other Other Studies StudiesCancer 48.1 74.0 American Cancer Society SocietyCOPD, Asthma 45.2 45.3 31.5 31.5American Lung Lung Association AssociationDiabetes 27.1 27.2 92.0 American Diabetes Diabetes Association AssociationHeart Disease, Stroke Stroke 78.3 78.5 242.0 Centers for for Disease Disease Control Control and and Prevention PreventionHypertension 32.5 32.6 – Centers for Disease Control Control and and Prevention PreventionMental Disorders 45.8 45.9 92.0 National Mental Health Health Association/CDCAssociation/CDCBecause this study is addressing a larger economic context, the summary of historical direct costs (treatment costs)excludes the costs of comorbidities and secondary effects. Nowhere is this more apparent than with diabetes. TheAmerican Diabetes Association included the cost of all comorbidities when it determined that $91.8 billion in directcosts for 2002 were attributable to the disease. 4If comorbidity costs are removed, the costs are the same as the MEPS total for the year.With the exception of blindness and amputation, most significant diabetes comorbidities are examined as part of theoverall cost of our study. However, since the secondary effects of diabetes are often diseases unto themselves or arerelated to other factors (cancers, hypertension, and obesity), these treatment costs are excluded from diabetes-specific costs.It is important to note when comparing estimates of direct costs that this study uses the direct costs to establishbenchmarks for projecting future increases in both direct and indirect impacts. In order to establish benchmarks, wemust create a uniform methodology that eliminates the possibility of cost overlap or replication. This approach is notintended to underestimate or understate the impacts of the individual diseases. But it is necessary in order to examinethe economic costs of each disease in terms of historic context and projections.2. Prevalence is used to define the number of individuals with a disease, while incidence refers to the numbers of newcases reported in a given year.3. David M. Cutler et al. “Measuring the Health of the U.S. Population.” Brookings Papers on Economic Activity, 1997: 218.4. American Diabetes Association. “Economic Costs of Diabetes in the U.S. in 2002.” Diabetes Care, March, 2003;26(3):917-932[ 39 ]