The global impact of non-communicable diseases on healthcare spending and national income: a systematic review

Abstract

The impact of non-communicable diseases (NCDs) in populations extends beyond ill-health and mortality with large financial consequences. To systematically review and meta-analyze studies evaluating the impact of NCDs (including coronary heart disease, stroke, type 2 diabetes mellitus, cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease and chronic kidney disease) at the macro-economic level: healthcare spending and national income. Medical databases (Medline, Embase and Google Scholar) up to November 6th 2014. For further identification of suitable studies, we searched reference lists of included studies and contacted experts in the field. We included randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults assessing the economic consequences of NCDs on healthcare spending and national income without language restrictions. All abstracts and full text selection was done by two independent reviewers. Any disagreements were resolved through consensus or consultation of a third reviewer. Data were extracted by two independent reviewers using a pre-designed data collection form. Studies evaluating the impact of at least one of the selected NCDs on at least one of the following outcome measures: healthcare expenditure, national income, hospital spending, gross domestic product (GDP), gross national product, net national income, adjusted national income, total costs, direct costs, indirect costs, inpatient costs, outpatient costs, per capita healthcare spending, aggregate economic outcome, capital loss in production levels in a country, economic growth, GDP per capita (per capita income), percentage change in GDP, intensive growth, extensive growth, employment, direct governmental expenditure and non-governmental expenditure. From 4,364 references, 153 studies met our inclusion criteria. Most of the studies were focused on healthcare related costs of NCDs. 30 studies reported the economic impact of NCDs on healthcare budgets and 13 on national income. Healthcare expenditure for cardiovascular disease (12-16.5 %) was the highest; other NCDs ranged between 0.7 and 7.4 %. NCD-related health costs vary across the countries, regions, and according to type of NCD. Additionally, there is an increase in costs with increased severity and years lived with the disease. Low- and middle-income (LMI) countries were the focus of just 16 papers, which suggests an information shortage concerning the true economic burden of NCDs in these countries. NCDs pose a significant financial burden on healthcare budgets and nations' welfare, which is likely to increase over time. However further work is required to standardize more consistently the methods available to assess the economic impact of NCDs and to involve (hitherto under-addressed) LMI populations across the globe.

Lower-Income Countries That Face The Most Rapid Shift In Noncommunicable Disease Burden Are Also The Least Prepared

“…Most such diseases are chronic, require health delivery infrastructure and skilled workforces, and are costly to treat. 27 For example, a recent study in Tanzania revealed that noncommunicable diseases were responsible for only 27 percent of the country's health burden but for nearly half of its hospital admissions and hospitalization days. 28 Studies conducted in the United States and New Zealand showed higher rates of inpatient surgical procedures for the treatment of noncommunicable diseases than for that of communicable, maternal, and neonatal diseases (34 percent versus 24 percent in the United States and 32 percent versus 16 percent in New Zealand).…”

Deriving more value from RWE to ensure timely access of medicines by patients

“…Healthcare costs are rising at a much faster rate than gross domestic product (GDP), creating budget deficiencies [5]. This reinforces payers to ensure that they put money in treatments that are cost effective, add value to patients and improve population health.…”

“…Parallel to this, global public health trends show increasing burden of noncommunicable diseases due to unhealthy lifestyle [5], implying a large proportion of people living a long unhealthy life about 30-40 years.…”

“…Technological advancement enables quick flow of data and information, thus increasing level of knowledge on health and on what works and what does not [4]. Patients have high expectations on health systems to offer safe and effective treatments.Parallel to this, global public health trends show increasing burden of noncommunicable diseases due to unhealthy lifestyle [5], implying a large proportion of people living a long unhealthy life about 30-40 years.Healthcare costs are rising at a much faster rate than gross domestic product (GDP), creating budget deficiencies [5]. This reinforces payers to ensure that they put money in treatments that are cost effective, add value to patients and improve population health.…”

Adherence challenges encountered in an intervention programme to combat chronic non-communicable diseases in an urban black community, Cape Town

“…Because of their chronicity, these diseases place an increased demand on the healthcare sector, with an increasing number of persons requiring specialised care. In addition, the fact that many of those affected by CNCD are of working-age, affects the country's economic growth through productivity losses and prolonged disability (Ezzati & Riboli, 2012;Muka et al, 2015).…”