Cost of Illness

The economic impact of diseases on society

This chapter presents the results of the cost of illness estimates for the Belgian National Burden of Disease Study (BeBOD). The BeBOD study quantifies the health impact of 38 key diseases in terms of Disability-Adjusted Life Years (healthy life years lost due to morbidity and mortality).

The cost of illness study complements the health impact estimates by providing a description of the economic impact of diseases on our society. Looking at different types of information (health impact, economic impact) helps governments and service providers have better evidence to figure out what is most important and shape plans and policies that can meet the needs of the people affected.

To calculate the economic impact of diseases in Belgium, we estimated the costs of hospitalizations and outpatient visits, including medication (direct medical costs). We analyzed self-reported non-communicable health conditions, health conditions identified through medication use, cancer, and hospital stays.

1. Self-reported non-communicable health conditions
   Musculoskeletal disorders had the highest economic burden in 2018 of all self-reported health conditions included in the analysis. Musculoskeletal disorders are common, and associated with moderately high medical expenses. The total medical costs of self-reported health conditions were lower in 2018 compared to 2013, except for eye diseases.
2. Health conditions identified through medication use
   The economic burden was highest for heart diseases, exceeding 2.7 billion euros in 2022. Diabetes showed the sharpest rise in costs between 2013 and 2022, even after adjusting for inflation, mainly due to an increase in the average attributable cost per patient. Costs also increased for 25 other diseases after adjusting for inflation, primarily driven by a growing number of patients, while they decreased for 9 diseases as a result of a lower costs per patient and/or a decreasing number of patients.
3. Cancer
   Lung cancer is the most costly cancer, followed by colon and rectum cancer, and breast cancer. Lung cancer is both common and costly to treat. Many of the high cost cancers can be prevented by tackling risk factors such as smoking, obesity, and environmental stressors.
4. Hospital stays
   We examined the costs for hospital stays for cirrhosis of the liver, acute cerebrovascular disease (stroke), and acute myocardial infarction (heart attack). In 2021, stroke accounted for the highest total hospital costs, which increased over time primarily as a result of higher average costs per hospital stay, while costs associated with heart attack and cirrhosis showed little change.

What does it mean when a disease is linked to high direct medical costs?

It is important to understand that diseases and their effects on people, society, and the health system are complicated. A disease might have a big impact on people but not cost a lot in terms of health spending, or the other way around. When a disease has a high human cost but low spending, it does not automatically mean that more money should be spent on healthcare. Some treatments are more expensive, and for issues like road transport injuries or smoking-related diseases, the solutions may involve investments and actions outside the health system, like in education, transportation, environmental health, or other social services [1].

Different diseases, different data sources

The costs of the different diseases are estimated based on different data sources. The best data source for each of the diseases is determined by a critical appraisal [2]. Currently, the estimates are based on four different data sources: 

1. Self-reported non-communicable health conditions
   Health Interview Survey linked to data from the Intermutualistic Agency [3,4]
2. Health conditions identified through medication use
   Permanent Sample of the Intermutualistic Agency [5]
3. Cancer
   Belgian Cancer Registry linked to data from the Intermutualistic Agency [6]
4. Hospital stays
   Hospital discharge data from the Technical Cell for data processing regarding hospitals [7,8]

Since it is difficult to compare costs from different data sources, we present the costs of the different diseases by data source.