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Health conditions identified through medication use

  1. Key messages
  2. Costs of health conditions identified through medication use
  3. Read more

1. Key messages

  • In 2022, expenditure on direct medical care for heart diseases such as heart failure and angina pectoris amounted to more than 2.7 billion euros
  • Diabetes saw the sharpest rise in costs between 2013 and 2022, also after adjusting for inflation, mainly due to an increase in the average attributable cost per patient
  • For all 26 conditions whose costs rose after adjusting for inflation, the number of patients increased; for 16 of these conditions, the average cost per patient also rose
  • For 15 of the 35 conditions studied, the average expenditure per patient in 2022 was lower than in 2013, after adjusting for inflation

2. Costs of health conditions identified through medication use

The highest costs were calculated for heart diseases, depression and diabetes

The figure below shows the direct medical costs of 35 different conditions compared to a situation where no one had those conditions (attributable costs). The additional expenditure on direct medical care for people with heart diseases such as heart failure and angina pectoris amounted to more than 2.7 billion euros in 2022. For depression and diabetes, the expenditure was estimated at around 2 billion euros. Three other conditions for which the costs were estimated at over 1 billion euros were COPD and severe asthma, patients treated with anticoagulants or antiplatelet agents for the prevention or treatment of blood clots (thrombosis), and psychosis. For some conditions, the attributable costs were estimated to be relatively low, such as growth disorders, pulmonary arterial hypertension (PAH) and rheumatism.

Ranking of direct medical costs for 35 conditions, Belgium, 2022 
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

The total cost of a condition is related to both the average cost per patient and the number of patients

The total cost of a condition was calculated by multiplying the average cost per patient by the number of patients. The bubble plot shows the extent to which the total cost is determined by these two factors. The size of the bubble reflects the total cost. 

For heart diseases, the high total costs were due to both a high average cost per patient and a relatively large number of patients. For depression and diabetes, on the other hand, the average cost per patient was not particularly high, but the number of patients was. Growth disorders and pulmonary arterial hypertension were less common, but were associated with a relatively high average cost per patient.

Direct medical costs for 35 conditions as a product of the average cost per patient and the number of patients, Belgium, 2022
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

Most conditions saw an increase in direct medical costs between 2013 and 2022, even after adjusting for inflation and population ageing

For 33 of the 35 conditions, total costs increased between 2013 and 2022. The most striking increases in absolute terms were seen in diabetes (+2 billion euros; +4,532%), heart diseases (+1.2 billion euros; +77%), patients treated with anticoagulants (+938 million euros; +493%), depression (634 million euros; +44%) and neuropathic pain (+527 million euros; +273%).

In addition to the observed evolution of total costs over time, we calculated the evolution of total costs adjusted for inflation and/or population ageing.

When inflation was taken into account, total costs rose for 26 of the 35 conditions. This is because for 7 conditions, costs rose less rapidly than inflation. After adjusting for inflation, the most notable increases were seen in diabetes (+2 billion euros; +3,665%), patients treated with anticoagulants (+895 million euros; +382%), heart diseases (+838 million euros; +44%), neuropathic pain (+482 million euros, +203%) and kidney diseases (+429 million euros; +203%).

By standardising the population by age, it is possible to correct for the effects of population ageing. For heart diseases, this adjustment reduced the apparent increase in costs, bringing the total down to 980 million euros. In other words, if the age structure of the population had remained the same, the costs for heart diseases would have been limited to 980 million euros instead of 1.2 billion euros. After correcting for population ageing, costs increased notably for diabetes (+2 billion euros; +4,253%), patients treated with anticoagulants (+915 million euros; +428%), depression (+532 million euros; +35%) and neuropathic pain (+509 million euros; +242%).

When adjusting for both inflation and population ageing, there was still an increase in total costs for 25 of the 35 conditions. The most striking increases were seen in diabetes (+2 billion euros; +3,438%), patients treated with anticoagulants (+866 million euros; +329%), heart diseases (+571 million euros; +26%), neuropathic pain (+461 million euros; +178%) and kidney diseases (+404 million euros; +172%).

  • Observed
  • Adjusted for inflation
  • Age-standardised
  • Age-standardised and adjusted for inflation

Evolution of direct medical costs for 35 conditions, Belgium, 2013-2022
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

Evolution of direct medical costs for 35 conditions, adjusted for inflation, Belgium, 2013-2022
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

Evolution of direct medical costs for 35 conditions, standardised by age, Belgium, 2013-2022
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

Evolution of direct medical costs for 35 conditions, standardised by age and adjusted for inflation, Belgium, 2013-2022 
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

The average cost per patient increased for most conditions between 2013 and 2022

For 28 of the 35 conditions, the average cost per patient increased between 2013 and 2022. The most notable increases in absolute terms were seen in cystic fibrosis (+10,897 euros; +83%), psoriasis (+9,159 euros; +343%), use of immunoglobulin in cases of reduced immunity (+8,613 euros; +28%), heart diseases (+5,384 euros; +75%) and Alzheimer’s disease (+3,693 euros; +57%). After adjusting for inflation, there was still an increase for 20 conditions, with the most notable increases in psoriasis (+8,684 euros; +343%), cystic fibrosis (+7,883 euros; 49%), heart diseases (+3,735 euros; +42%), chronic anticoagulation (+2,642 euros; +91%) and diabetes (+2,564 euros; +3.613%).  

For 15 of the 35 conditions, the average cost per patient decreased after adjustment for inflation, indicating that, on average, less was spent per person on these conditions in 2022 than in 2013. The conditions for which the average cost per patient decreased most significantly after adjustment for inflation were COPD/severe asthma (-10,604 euros; -43%), kidney diseases (-8,230 euros; -15%), HIV/AIDS (-7,309 euros; -54%) and autoimmune diseases (-6,803 euros; -40%). 

  • Observed
  • Adjusted for inflation

Evolution of the average cost per patient for 35 conditions, Belgium, 2013-2022
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

Evolution of the average cost per patient for 35 conditions, adjusted for inflation, Belgium, 2013-2022
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

The prevalence of most conditions increased between 2013 and 2022, partly due to population ageing

The prevalence of conditions was estimated based on the use of reimbursed medicines and may differ from the actual prevalence when a condition is not treated with medication or is treated with medication other than that used to define the condition.

For 29 of the 35 conditions, the number of patients increased between 2013 and 2022. The largest increases in absolute numbers were seen in chronic anticoagulation (+122,834; +153%), depression (+121,478; +24%), asthma (+76,867; +46%), neuropathic pain (+59,922; +214%), macular degeneration (+53,831; +136%) and autoimmune diseases (+38,277; +215%). After standardisation by age, there was an increase for 27 conditions. The sharp increase in cases of depression was partly caused by population ageing: after standardisation by age, the increase was limited to 85,932 (+16%).

The largest decreases in prevalence were seen in Alzheimer’s disease (-10,999; -33%) and Crohn's disease (-4,735; -11%). After standardisation by age, this corresponded to a decrease of 16,219 (-42%) and 7,429 (-16%) respectively.

  • Observed
  • Age-standardised

Evolution of the number of patients for 35 conditions, Belgium, 2013-2022
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

Evolution of the number of patients for 35 conditions, standardised by age, Belgium, 2013-2022
Source: Own calculations based on data from the Intermutualistic Agency [1]. The ‘add-on-based’ FKG groups are groups compiled by the Dutch Healthcare Institute based on hospital medication.

3. Read more

Discover the study protocol

Background

Data source

The data source for this analysis is the Permanent Sample of the Intermutualistic Agency. This sample is a database on the use of healthcare. The data does not cover the entire population, but a representative selection based on age and gender. It contains data on consultations and visits to doctors, prescribed medications, hospital admissions, nursing services, etc. [1, 2].

How we calculate medical costs of health conditions identified through medication use

We estimate the marginal or additional costs attributable to a health condition identified through medication use. Individuals with a particular condition are identified through their use of specific medications. When calculating these costs, we adjust for factors that may also influence costs, such as age, gender, reimbursement status (as an indication of income or disability) and the region where a person lives. By taking these factors into account, we obtain a clearer picture of the actual impact of a disease on costs.

Definitions

Health conditions identified through medication use

The Permanent Sample contains information about prescribed medicines. This information is used to determine who is likely to have a particular condition. For 33 conditions, we use the Pharmaceutical Cost Groups (FKG) as assigned by the Intermutualistic Agency (IMA) [1, 3]. The Dutch National Health Care Institute (Zorginstituut Nederland) updates the list of medicines assigned to the Pharmaceutical Cost Groups (FKG) annually [4]. A person belonged to an FKG if, in the reference year, more than the minimum threshold value of one or more associated ATC (Anatomical Therapeutic Chemical) codes was delivered. The FKG “based on add-on” are groups compiled by the Dutch National Health Care Institute based on hospital medication. 

For diabetes and Alzheimer’s disease, we used our own algorithms based on the (former) “pseudodiagnoses” of IMA. These algorithms are based on medication use and, in the case of diabetes, also on the use of specific healthcare services.

Direct medical costs
Direct medical costs include all costs associated with hospital admissions, outpatient visits and reimbursed medication use. Long-term care and psychiatric care are generally not included in the analysis unless the costs are covered by compulsory health insurance. These costs may be covered directly by compulsory health insurance, reimbursed to patients after they have paid, or paid out of pocket.
Correction for inflation
Adjusting for inflation means that all monetary values are expressed in the prices of the same year. This is done by using an index (Statbel's health index) that adjusts for changes in the general price level over time [5]. This avoids cost differences between years being solely the result of price increases in the economy, and allows fairer comparisons of actual changes in healthcare expenditure.
Standardisation by age
Age-standardisation is a statistical technique whereby raw figures (such as incidence, prevalence or mortality rates) are adjusted to a reference population with a fixed age structure. This eliminates the effect of differences in age distribution between populations or over time. By applying age-standardisation, researchers and policymakers can gain insight into trends while minimising the distorting influence of age-related variations. Here, the Belgian population of 2022 is used as the reference population [5].
References
  1. Metadata : db Échantillon Permantent(e) Steekproef (EPS), Intermutualistic Agency. https://metadata.aim-ima.be/nl/app/bdds/Ps 
  2. Onze gezondheidszorg evalueren via de ‘permanente steekproef'. RIZIV/INAMI. https://www.riziv.fgov.be/nl/publicaties/onze-gezondheidszorg-evalueren-via-de-permanente-steekproef
  3. Metadata: var FKG_XXX-Farmaciekostengroep (FKG) XXX (Patiëntendata). https://metadata.ima-aim.be/nl/app/vars/FKG_XXX_Pa
  4. https://www.zorginstituutnederland.nl/
  5. https://statbel.fgov.be/nl 

Please cite this page as: Sciensano. Cost of illness: health conditions identified through medication use, Health Status Report, 7 Oct 2025, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/cost-of-illness/health-conditions-based-on-medication-use