Abstract
Background:
Across OECD member countries, non-communicable diseases (NCDs) accounted for nearly 90% of deaths and over half of disability-adjusted life years lost. NCD health expenditure estimates are necessary to estimate future health expenditure trajectories for different prevention and treatment policies. However, no dataset of comparable estimates exists across OECD countries.
This study generates disease expenditure estimates in all 38 OECD member countries in 2019, for 80 major NCDs by disease phase, sex, and age group – filling a critical information gap in global health data.
Methods:
Health expenditure per person with disease by sex and age group was taken from a comprehensive Australian disease expenditure study and disaggregated by disease phase (first year of diagnosis, last year of life if dying of disease, otherwise prevalent) using Global Burden of Disease data and New Zealand estimates of relative expenditure ratios by phase. These estimates were applied to case numbers in each OECD country and scaled to each country’s total health system expenditure to estimate total NCD expenditure in 2019 United States dollars by disease phase. Estimates were compared with pre-existing disease expenditure estimates for Norway, Switzerland, and the United States of America.
Results:
Average health expenditure on NCDs across OECD countries was US$207 million per 100,000 population. Pooled across countries, musculoskeletal disorders contributed to the highest proportion of total health expenditure (17.4%), followed by cancer and other neoplasms (9.4%), and CVD (9.1%). The highest proportion expenditure conditions for females were musculoskeletal disorders (56.1%), mental and substance use disorders (55.8%), and neurological conditions (54.8%). For males it was kidney and urinary diseases (63.8%), cancer and other neoplasms (58.3%), and cardiovascular diseases (50.7%). The first year of diagnosis represented on average 36.8% of total NCD expenditure, while last year of life expenditure attributable to disease causing death accounted for 2.6%.
Similarities and differences were observed between our estimates and pre-existing country-specific estimates.
Conclusions:
Our estimates represent a starting point for understanding the impact of NCDs on health system expenditure. We recommend evolving our paper’s methods to include multiple country-level studies as inputs – augmented by covariates (e.g. GDP, public/private split) to better predict disease expenditure.