Disease Management and Health Outcomes

, Volume 8, Issue 1, pp 29–41 | Cite as

Cost Estimates for Chronic Diseases

  • Jean Woo
  • Clive Cockram
Review Article


With increasing chronic disease and disability burden as a result of the aging of populations worldwide, cost estimates of disease and disability are important in determining: (i) the most cost-effective methods in delivering healthcare in order to maximise resources; and (ii) health policies and resource allocation. Cost may be divided into direct, indirect and intangible costs. Economic evaluations include cost-benefit, cost-effectiveness and cost-utility studies. In obtaining data for these studies, a multidisciplinary effort is required. Data include epidemiological, healthcare utilisation and cost data (e.g. based on disease-related groups), outcome measures and national sickness, unemployment and productivity figures.

Examples of cost-of-illness studies show that chronic diseases constitute a significant economic burden for societies, in terms of either direct or indirect costs. Using such data, healthcare policies may be formulated towards cost reduction, whether preventive or interventional. Decisions regarding choice of drug treatments or methods of service delivery may also be based on such information. Conflicting perspectives from healthcare providers, society or individual view-points may render decisions regarding resource allocation based on such estimates controversial.


Economic Evaluation Indirect Cost Direct Cost Alendronic Acid Human Capital Approach 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Murray CJL, Lopez AD. The global burden of disease. Geneva: World Health Organization, 1996Google Scholar
  2. 2.
    Taylor TN. The medical economics of stroke. Drugs 1997; 54 Suppl. 3: 51–8PubMedCrossRefGoogle Scholar
  3. 3.
    Palmer S, Byford S, Raftery J. Types of economic evaluation. BMJ 1999; 318: 1349PubMedCrossRefGoogle Scholar
  4. 4.
    Lane A. Direct costs of osteoporosis for New Zealand women. Pharmacoeconomics 1996; 9: 231–45PubMedCrossRefGoogle Scholar
  5. 5.
    Koopmanschap MA, Rutten FFH. A practical guide for calculating indirect costs of disease. Pharmacoeconomics 1996; 10(5): 460–6PubMedCrossRefGoogle Scholar
  6. 6.
    The WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 1995; 41(10): 1403–9CrossRefGoogle Scholar
  7. 7.
    Stewart AL, Hays RD, Ware JE. The MOS short form general health survey: reliability and validity in a patient population. Med Care 1988; 26(7): 724–35PubMedCrossRefGoogle Scholar
  8. 8.
    Bergner M, Bobbitt R, Pollard W, et al. The sickness impact profile: development and final revision of a health status measure. Med Care 1976; 19: 787–805CrossRefGoogle Scholar
  9. 9.
    Harwood RH, Gompertz P, Ebrahim S. Handicap one year after a stroke: validity of a new scale. J Neurol Neurosurg Psychiatry 1994; 57: 825–9PubMedCrossRefGoogle Scholar
  10. 10.
    Gryatt GH, Berman LB, Townsend M, et al. A measure of quality of life for clinical trials in chronic lung disease. Thorax 1987; 42: 773–8CrossRefGoogle Scholar
  11. 11.
    Cohen SR, Mount BM, Bruera E, et al. Validity of the McGill quality of life questionnaire in the palliative care setting: a multi-centre Canadian study demonstrating the importance of the existential domain. Palliat Med 1997; 11: 3–20PubMedCrossRefGoogle Scholar
  12. 12.
    Kaplan RM, Coons SJ, Anderson JP. Quality of life and policy analysis in arthritis. Arthritis Care Res 1992; 5(3): 173–83PubMedCrossRefGoogle Scholar
  13. 13.
    Byford S, Raffery J. Perspectives in economic evaluation. BMJ 1998; 316: 1529–30PubMedCrossRefGoogle Scholar
  14. 14.
    Briggs A. Handling uncertainty in economic evaluation. BMJ 1999; 319: 120PubMedCrossRefGoogle Scholar
  15. 15.
    Briggs AH, Gray AM. Handling uncertainty in economic evaluations of healthcare interventions. BMJ 1999; 319: 635–8PubMedCrossRefGoogle Scholar
  16. 16.
    Baltussen R, Leidl R, Ament A. The impact of age on cost-effectiveness ratios and its control in decision making. Health Econ 1996; 5: 227–39PubMedCrossRefGoogle Scholar
  17. 17.
    Williams A, Kind P. The present state of play about QALYs: In: Hopkins A, editor. Measures of the quality of life and the uses to which such measures may be put. London: Royal College of Physicians, 1992Google Scholar
  18. 18.
    Froberg DG, Kane RL. Methodology for measuring health-state preferences-II: Scaling Methods. J Clin Epidemiol 1989; 42: 459–71PubMedCrossRefGoogle Scholar
  19. 19.
    The EuroQol Group. EuroQol: a new facility for the measurement of health related quality of life. Health Policy 1990; 16: 199–208CrossRefGoogle Scholar
  20. 20.
    Gold MR, Franks P, McCoy KI, et al. Toward consistency in cost-utility analyses: using national measures to create condition-specific values. Med Care 1998; 36: 778–92PubMedCrossRefGoogle Scholar
  21. 21.
    Togerson DJ, Raftery J. Discounting. BMJ 1999; 319: 914–5CrossRefGoogle Scholar
  22. 22.
    Hoffman C, Rice D, Sung HY. Persons with chronic conditions. Their prevalence and costs. JAMA 1997; 277(5): 375–6Google Scholar
  23. 23.
    Ireys HT, Anderson GF, Shaffer TJ, et al. Expenditures for care of children with chronic illnesses enrolled in the Washington State medicaid program, fiscal year 1993. Pediatrics 1997; 100(2): 197–204PubMedCrossRefGoogle Scholar
  24. 24.
    Powe NR, Weiner JP, Starfield B, et al. Systemwide provider performance in a Medicaid Program: profiling the care of patients with chronic illnesses. Med Care 1996; 34(8): 798–810PubMedCrossRefGoogle Scholar
  25. 25.
    Meerding WJ, Bonneux L, Polder JJ, et al. Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study. BMJ 1998; 317: 111–5PubMedCrossRefGoogle Scholar
  26. 26.
    Tsuji I, Kuwahara A, Nishimo Y, et al. Medical cost for disability: a longitudinal observation of National Health Insurance beneficiaries in Japan. J Am Geriatr Soc 1999; 47: 470–6PubMedGoogle Scholar
  27. 27.
    Woo J, Ho SC, Yu LM, et al. Impact of chronic diseases on functional limitation in elderly Chinese age 70 years and over: A cross sectional and longitudinal survey. J Gerontol 1998; 53A(2): M102–6CrossRefGoogle Scholar
  28. 28.
    Barret-Connor E. The economic and human costs of osteoporotic fracture. Am J Med 1995; 98 Suppl. 2A: 3S–8SCrossRefGoogle Scholar
  29. 29.
    Ho SC, Lau EMC, Woo J, et al. The prevalence of osteoporosis in Hong Kong Chinese female population. Maturitas 1999; 32: 171–8PubMedCrossRefGoogle Scholar
  30. 30.
    Schwartz AV, Kelsey JL, Maggi S, et al. International variations in the incidence of hip fractures: the World Health Organization Cross-National project on osteoporosis. Osteoporosis Int 1999; 9: 242–53CrossRefGoogle Scholar
  31. 31.
    Reid IR. Osteoporosis — emerging consensus. Aust NZ J Med 1997; 27: 643–7CrossRefGoogle Scholar
  32. 32.
    Yelin E, Callahan LF. The economic cost and social and psychological impact of musculoskeletal conditions. Arthritis Rheum 1995; 38: 1351–62PubMedCrossRefGoogle Scholar
  33. 33.
    Lorig K, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993; 36: 439–46PubMedCrossRefGoogle Scholar
  34. 34.
    Gillum RF, Wilson JB. The burden of stroke and its sequelae. Dis Manage Health Outcomes 1997; 1(2): 84–94CrossRefGoogle Scholar
  35. 35.
    Dobkin B. The economic impact of stroke. Neurology 1995; 45 Suppl. 1: S6–S9PubMedGoogle Scholar
  36. 36.
    Porsdal V, Boysen G. Cost-of-illness studies of stroke. Cerebrovasc Dis 1997; 7: 258–63CrossRefGoogle Scholar
  37. 37.
    Woo J, Ho SC, Chan SG, et al. An estimate of chronic disease burden and some economic consequences among the elderly Hong Kong population. J Epidemiol Community Health 1997; 51:486–9PubMedCrossRefGoogle Scholar
  38. 38.
    McMurray J, Hart W, Rhodes G. An evaluation of the cost of heart failure to the National Health Service in the UK. Br J Med Econ 1993; 6: 99–110Google Scholar
  39. 39.
    Thom TJ, Kannel WB. Congestive heart failure: epidemiology and cost of illness. Dis Manage Health Outcomes 1997; 1(2): 75–83CrossRefGoogle Scholar
  40. 40.
    Pickin DM, McCabe CJ. Lipid lowering in the United Kingdom National Health Service: effectiveness and cost — the economic view. Proc Roy Coll Phys Edin 1999; 29 (2 Suppl. 5): 31–40Google Scholar
  41. 41.
    Barnes PJ, Jonsson B, Klim JB. The costs of asthma. Eur Respir J 1996; 9: 636–42PubMedCrossRefGoogle Scholar
  42. 42.
    Scott WG, Scott HM, Frost GD. Pharmacoeconomic evaluations of asthma treatment costs. Br J Med Econ 1997; 11: 87–101Google Scholar
  43. 43.
    Chew FT, Goh DYT, Lee BW. The economic cost of asthma in Singapore. Aust NZ J Med 1999; 29: 228–33CrossRefGoogle Scholar
  44. 44.
    Jonsson B, Bebbington PE. What price depression? The cost of depression and the cost effectiveness of pharmacological treatment. Br J Psychiatry 1994; 164: 665–73PubMedCrossRefGoogle Scholar
  45. 45.
    Simon GE, Von Korff M, Barlow W. Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry 1995; 52: 850–6PubMedCrossRefGoogle Scholar
  46. 46.
    Rice DP, Miller LS. The economic burden of affective disorders. Br J Psychiatry 1995; 166 Suppl. 27: 34–42Google Scholar
  47. 47.
    Rupp A. The economic consequences of nottreating depression. Br J Psychiatry 1995; 166 Suppl. 2: 29–33Google Scholar
  48. 48.
    Max W. The cost of Alzheimer’s Disease: will drug treatment ease the burden? Pharmacoeconomics 1996; 9(1): 5–10PubMedCrossRefGoogle Scholar
  49. 49.
    O’Brien BJ, Goeree R, Hux M, et al. Economic evaluation of Donepezil for the treatment of Alzheimer’s disease in Canada. J Am Geriatr 1999; 47: 570–8Google Scholar
  50. 50.
    Songer TJ, LaPorte RE, Lave JR, et al. Health insurance and the financial impact of IDDM in families with a child with IDDM. Diabetes Care 1997; 20: 577–84PubMedCrossRefGoogle Scholar
  51. 51.
    Taylor A. Medical expenditures and insurance coverage for people with diabetes: estimates from the national medical care expenditure survey. Diabetes Care 1987; 10: 87–94PubMedCrossRefGoogle Scholar
  52. 52.
    Songer TJ, DeBerry K, LaPorte RE, et al. International comparisons of IDDM mortality: clues to prevention and the role of diabetes care. Diabetes Care 1992; 15 Suppl. 1: 15–21PubMedGoogle Scholar
  53. 53.
    Shobhana R, Rama Rao P, Lavanya A, et al. Expenditure on health care incurred by diabetic subjects in a developing country — a study from Southern India. Diabetes Res Clin Pract. In pressGoogle Scholar
  54. 54.
    Jönsson B. The economic impact of diabetes. Diabetes Care 1998; 21 Suppl. 3: C7–C10PubMedGoogle Scholar
  55. 55.
    Rubin RJ, Airman WM, Mendelson DN. Health care expenditures for people with diabetes mellitus, 1992. J Clin Endocrinol Metab 1994; 78: 809A–9FPubMedCrossRefGoogle Scholar
  56. 56.
    Direct and indirect costs of diabetes in the United States in 1992. Alexandria (VA): American Diabetes Association, 1993Google Scholar
  57. 57.
    Birmingham CL, Muller JL, Palepu A, et al. The cost of obesity in Canada. Can Med Assoc J 1999; 160(4): 483–8Google Scholar
  58. 58.
    Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res 1998; 6(2): 97–106PubMedGoogle Scholar
  59. 59.
    Alberti KGMM. The costs of non—insulin-dependent diabetes mellitus, editorial. Diabetes Med 1997; 14: 7–9CrossRefGoogle Scholar
  60. 60.
    Kings Fund. Counting the cost: the real impact of non-insulindependent diabetes mellitus. London: British Diabetic Association, 1996Google Scholar
  61. 61.
    Gruber W, Lander T, Leese B, et al., editors. The economics of diabetes and diabetes care. A report of a Diabetes Health Economics Study Group. Brussels: International Diabetes Federation, and Geneva: World Health Organization, Division of Noncommunicable Diseases, 1998Google Scholar
  62. 62.
    American Diabetes Association. Economic consequences of diabetes in the US in 1997. Diabetes Care 1998; 21: 296–309CrossRefGoogle Scholar
  63. 63.
    McCarty DJ, Zimast P, Dalton A, et al. The rise and rise of diabetes in Australia, 1996: a review of statistics, trends and costs. Victoria, Australia: International Diabetes Institute/Diabetes Australia, 1996Google Scholar
  64. 64.
    Persson U. The indirect costs of morbidity in type II diabetic patients. Pharmacoeconomics 1995; 8 Suppl. 1: 28–32PubMedCrossRefGoogle Scholar
  65. 65.
    Rubin RR, Peyrot M. Quality of life and diabetes. Diab Metab Res Rev 1999; 15: 205–18CrossRefGoogle Scholar
  66. 66.
    Anonymous. Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial. The diabetes control and complications trial research group. JAMA 1996; 276(17): 1409–15CrossRefGoogle Scholar
  67. 67.
    UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53CrossRefGoogle Scholar
  68. 68.
    Pan, X-r, Li GW, Hu YH, et al. Effects of diet and exercise in preventing non—insulin-dependent diabetes mellitus in persons with impaired glucose tolerance: the Da Qing IGT and diabetes study. Diabetes Care 1997; 20: 537–44PubMedCrossRefGoogle Scholar
  69. 69.
    Diabetes Control and Complications Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86CrossRefGoogle Scholar
  70. 70.
    Araki E, Ohkiho Y, Kishidawa H, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective six-year study. Diabetes Res Clin Pract 1995; 28: 103–17PubMedCrossRefGoogle Scholar
  71. 71.
    Hannsson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) Randomized Trial. Lancet 1998; 351: 1755–62CrossRefGoogle Scholar
  72. 72.
    UK Prospective Diabetes Study Group. Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40. BMJ 1998; 317: 720–6CrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  1. 1.Department of Medicine & Therapeutics, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong SARChina

Personalised recommendations