Sindhu Kubendran
Senior Research Analyst, Health Economics Research
Sindhu Kubendran is a senior associate and research analyst at the Milken Institute who focuses on areas of public health that include prevention, wellness, chronic disease, and longevity. At the Institute, Kubendran is a co-author of the reports, “Healthy Savings: Medical Technology and the Economic Burden of Disease,” which examines...
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Doing the math on the costs of chronic disease
By: Sindhu Kubendran
January 31, 2014
In the 2007 report aEURoeAn Unhealthy America: The Economic Burden of Chronic Disease,aEUR? Milken Institute researchers projected the potential burdens of cancer, diabetes, heart disease, hypertension and stroke in economic terms as well as the number of people afflicted. This week, we released an update, aEURoeCheckup Time: Chronic Disease and Wellness in America,aEUR? in which we assess how the country is faring. In important ways, we found, the U.S. is fighting an uphill battle. The growth of treatment costs has generally slowed. Tempering that good news, though, the chronic disease population and the associated economic burden have grown even faster than expected.

In aEURoeAn Unhealthy America,aEUR? our projections were based on historical trends in the proportion of people suffering from the conditions we studied, risk factors linking behavior to disease, changes in treatment expenditures, and economic effects linked to lost productivity as well as costs. aEURoeCheckup TimeaEUR? used recent data from the federal Agency for Healthcare Research and Quality and Centers for Disease Control and Prevention to calculate total economic burden, prevalence and average treatment costs for each ailment.

One thing that stood out in our analysis was the comparison of those costs with our projections. While average treatment expenditures have risen for all diseases, they are lower than expected for every condition except heart disease. In other words, their growth rates have declined.

What created those gaps between projections and reality? First, letaEUR(TM)s look at heart disease. While the number of cases was lower than projected, overall treatment spending was greater, revealing an increase in the average cost. This could be due to greater use of expensive diagnostic tests such as echocardiograms and more frequent surgery. Furthermore, though fewer people than expected have the condition, perhaps those cases are, on average, more severe in an environment of increasing obesity and elevated cholesterol levels. This may have led to more time in expensive inpatient and emergency room settings.

Average treatment costs for cancer, hypertension, and diabetes, on the other hand, came in under our projections. Screening for breast, cervical and colon cancer is a more common practice, possibly spurred by strong recommendations from the CDC and the U.S. Preventive Services Task Force. Done at proper intervals, such exams enable earlier detection, potentially making these diseases easier to treat and reducing average costs.

Self-management is imperative for people with hypertension and diabetes, and they are getting better at it. Improvements in provider-patient communication and the spread of health education have likely boosted patientsaEUR(TM) abilities and generated savings. More effective drugs reduce expensive medical complications, and FDA approval of generics may also make access to treatment cheaper and easier for patients.

We saw the best cost performance relative to projections with stroke, amid advances in detection and treatment. Indeed, innovators can look to stroke as a case study in drug and device development. Better diagnostics reveal smaller and less severe strokes, which had often gone under the radar in the past. That probably explains part of the large increase in the stroke population as well as the scaling down of average cost because smaller strokes are less expensive to treat. These are interesting results that warrant further investigation.

Our aEURoeCheckup TimeaEUR? report brings many sobering facts to light, notably the heavier economic burden and the larger population living with chronic conditions. While progress has been made in reducing treatment costs for some diseases, there is much work to do helping Americans live longer, healthier lives through all means, including education and prevention.


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