Cost of illness studies in health care: a comparison of two cases

doi:10.1016/0168-8510(93)90076-2

Health Policy

Volume 26, Issue 1, November 1993, Pages 29-42

https://doi.org/10.1016/0168-8510(93)90076-2 Get rights and content

Abstract

Cost of illness (COI) studies describe the economic burden of disease on society. In this article a standard procedure for a COI study is developed, including the explicit definition of the disease, choice of relevant variables and appraisal of direct and indirect costs. COI studies can be incidence-based or prevalence-based. The adjustment of cost figures for time preferences and the performance of a sensitivity analysis are presented. The standard methodology is applied to diseases in two different areas. The first disease category is dyspepsia, a complaint with a rather somatic background. The second is schizophrenia, a mental syndrome. In performing COI studies in practice, however, researchers are forced to deviate, in many aspects, from the theoretical standards. In this article these choices, and the reasons behind these choices, are explained. Furthermore, we discuss certain problems regarding the reluctance to make a diagnosis regarding certain diseases, the reliability and the validity of the sources used and the absence of certain figures. The value of the information derived from COI studies for policy-making is assessed.

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Furthermore, COI studies typically evaluate the cost of a particular disease. This can provide a fundamental basis for some economic evaluation studies, such as cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis studies [9]. There are three cost components estimated in a COI study.
The primary objective of this review was to identify the cost components that were most frequently associated with the economic burden of febrile neutropenia (FN) among patients with lymphoma. The secondary objective was to identify any parameter associated with higher FN cost. Ten cost of illness (COI) studies were identified. General characteristics on study design, country, perspective, and patient population were extracted and systematically reported. It was observed that majority (70%) of the studies employed the perspective of healthcare provider. 20% of the studies considered long-term costs. Estimated costs were adjusted to 2013 US dollars and ranged from US$5819 to US$34,756. The cost components that were most frequently associated with economic burden were ward and medication costs. Inpatient management, male gender, discharged dead, and comorbidity were positively associated with higher FN costs. Future COI studies on FN should focus on the accurate estimation on ward and medication costs.
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Cost-of-illness (COI) studies estimate the overall economic burden of a specific disease, rather than simply treatment-related costs. While having been criticized for not allowing resource prioritization, COI studies can provide useful guidance, so long as they adhere to accepted methodology. Prostate cancer is an important disease in terms of economic implications because of its increasing incidence and health-care costs and therefore provides a relevant example with which to review COI study methodologies. The aim of this study was to review published COI studies on prostate cancer to analyze the methods used.
First, we provide a general description of the COI method. COI studies relating to prostate cancer were then systematically reviewed, focussing on an analysis of the different methods used.
The methods, data sources, and estimated cost categories in each study varied widely. The review showed that COI studies adopted significantly different approaches to estimate the costs of prostate cancer, reflecting a lack of consensus on the methodology of COI studies in this area.
To increase its credibility, closer agreement among researchers on the methodological principles of the COI studies would be desirable.
Difficulties in calculating productivity costs: Work disability associated with borderline personality disorder
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In trial-based analyses, the Human Capital (HC) approach is currently applied alternately with and without the incorporation of productivity costs for persons who are work disabled at baseline of the trial. We call these methods HC-extended (HC_EXT) and HC-limited (HC_LIM), respectively. Aim of the paper is to compare productivity costs according to HC_EXT with HC_LIM and the Friction Cost (FC) method, in patients with Borderline Personality Disorder (BPD).
Data were obtained from a multicenter randomized trial in The Netherlands, comparing two types of outpatient psychotherapy, Schema Focused Therapy (SFT, n = 44) versus Transference Focused Psychotherapy (TFP, n = 42) for BPD. Mean age was 31.7 for SFT and 29.5 for TFP. A cost-interview was administered every three months for three years, and once again after the fourth year. Productivity costs were calculated according to HC_LIM, HC_EXT and FC. A nonparametric bootstrap resampling method was performed.
During the trial, the number of work-disabled patients increased for both treatments. Total productivity costs for HC_EXT were higher than for HC_LIM and FC. In addition, the incremental bootstrapped costs (TFP − SFT) pointed in the same direction for HC_LIM (€1168; 95% UI €4700, €7563) and FC (€1206; −€2835, €4844), but turned around for HC_EXT(minus €1240; −€9973, €7911). None of the increments were statistically significantly different from zero.
The classical and frequently discussed contrast between HC and FC is not the only difference when it concerns productivity costs. Whether or not including productivity costs for patients who are work-disabled at baseline can lead to contradictory conclusions.
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Citation Excerpt :
With this method, more comprehensive information on the cost of depression was generated to complement findings from prior top-down studies. A prevalence-based approach, looking at patients with the disease at a certain point in time, was considered appropriate in view of the chronic nature of depressive disorders [2]. The use of health care resources was collected from the patients and the accuracy of the data was constantly checked against the GPs records.
The purpose of the present study has been to assess the societal cost of major depression and the distribution into different cost components. The impact of adherence and treatment response was also explored.
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The mean total cost per patient during two years was KSEK 363 (EUR 38 953). Indirect costs were the most important component (87%), whereas the cost of drugs was minor (4.5%). No significant differences in costs or quality of life between treatment arms or between adherent and non-adherent patients were demonstrated. However, treatment responders had 39% lower total costs per patient and experienced a larger increase in quality of life compared to non-responders.
Major depression has high costs for society, primarily due to indirect costs. Treatment responders have considerably lower costs per patient and higher quality of life than non-responders. This indicates that measures to increase response rates are also important from an economic perspective.
Costs of occupational asthma in the UK
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Citation Excerpt :
A workplace-based individualised approach would have had the problem of being less likely to be extrapolated to the wider population, although it would have allowed more accurate assessment of workplace costs to the employer. Cost-of-illness studies (the approach used in this study) help identify the different components of the social cost of a disease but work on a range of assumptions.23 However, the assumptions made in this study are based on UK relevant and validated data in terms of health costs.
To estimate the social costs of occupational asthma in the UK.
A desk-top approach using cost-of-illness methodology was employed, defining direct and indirect lifetime costs for six scenarios: a male and a female worker each exposed to isocyanates, latex and biocides (eg, glutaraldehyde) or flour. The numbers of new cases annually in each industry were estimated from Survey of Work-related and Occupational Respiratory Disease (SWORD) data. The main outcome measure was the current value total working lifetime costs of new cases annually for each scenario.
Assuming 209 new cases of occupational asthma in the six scenarios in the year 2003, the present value total lifetime costs were estimated to be £25.3–27.3 million (2004 prices). Grossing up for all estimated cases of occupational asthma in the UK in 2003, this came to £70–100 million. About 49% of these costs were borne by the individual, 48% by the state and 3% by the employer.
The cost to society of occupational asthma in the UK is high. Given that the number of newly diagnosed cases is likely to be underestimated by at least one-third, these costs may be as large as £95–135 million. Each year a new stream of lifetime costs will be added as a newly diagnosed cohort is identified. Approaches to reduce the burden of occupational asthma have a strong economic justification. However, the economic burden falls on the state and the individual, not on the employer. The incentive for employers to act is thus weak.
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Cost of illness studies in health care: a comparison of two cases

Abstract

Social Science and Medicine

Political Arithmetic, or a Discourse Concerning the Extent and Value of Lands, People, Buildings, etc

The Wealth of Nations

The Money Value of Man

The cost of road accidents

Journal of the Royal Statistical Society

Economics of Mental Illness

Economics of public health: Measuring the economic impact of disease

Estimating the Cost of Illness

Cost-Benefit Analysis

The Value of Life: An Economic Analysis

Benefit-Cost Analysis for Program Evaluation

Methods for the Economic Evaluation of Health Care Programmes