Economic burden of osteoporosis, breast cancer, and cardiovascular disease among postmenopausal women in an employed population
ABSTRACT Postmenopausal women have a significant risk of developing a number of chronic conditions including osteoporosis (OP), breast cancer (BrCa), and cardiovascular disease (CVD). These diseases can result in significant direct (medical treatment) and indirect (workplace) costs. The objective of this study is to assess these costs among an employed population.
Deidentified medical and disability claims data from seven large employers (n = 585,441) were analyzed from 1998 through 2000 for female employees, age 50-64 years. Medical claim ICD-9CM codes were used to identify patients treated for: OP (n = 2,314), BrCa (n = 555), and CVD (n = 1,710). Each disease cohort was compared to a random sample of 50- to 64-year-old female employees (n = 7,575). Descriptive and multivariate techniques were used to characterize direct and indirect costs attributable to each condition.
Average annual direct costs were higher (p < .001) for female employees treated for OP (6,259 dollars), BrCa (13,925 dollars), or CVD (12,055 dollars) when compared with the random sample (2,951 dollars). In addition, average annual indirect costs associated with OP (4,039 dollars), BrCa (8,236 dollars), and CVD (4,990 dollars) were higher (p < .001) than indirect costs for the random sample (2,292 dollars). Even when controlling for each disease-state cohort's demographics and disease-specific comorbidities, patients treated for OP, BrCa, and CVD continued to have significantly greater direct and indirect costs (p < .001) than the random sample.
Chronic conditions such as OP, BrCa, and CVD, which occur more frequently in women after menopause, impose a significant financial burden. Greater health care utilization and work-loss prevalence among women treated for these conditions contribute to these additional costs.
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ABSTRACT: Across Europe and increasingly the rest of the world, the economic costs of chronic illness dwarf the costs of acute illnesses, both for the health care system and for other stakeholders. Employers must contend with substantial productivity losses, while the indirect costs of treatment that patients and families cope with can be debilitating, particularly when insurance coverage is less comprehensive. These economic costs can send ill patients and their families into poverty, creating a poverty cycle that may last for generations. Disparities in the burden of chronic disease exist between western Europe and the central and eastern countries, and current trends indicate that the burden of chronic illness is likely to grow. The current primary care model is focused more on acute episodes of care than recurrent care for chronic conditions. The implication is that strong doctor-patient relationships are not promoted, training is rarely sufficient for chronic disease management, and there is insufficient continuity and coordination of the patient's journey through the health care system. European countries have taken a variety of approaches to address the growing chronic disease burden. Austria, Belgium, England, Germany, Italy, the Netherlands, and Spain appear to be at the forefront of formal disease management programmes, although Denmark, Finland, France and Poland are also putting these types of chronic disease models into place. Most of the central and eastern European countries are lagging behind in terms of comprehensive models to deal with chronic care, although all have begun to implement some aspects of chronic disease management. Even in countries with the most comprehensive models of chronic disease management, there is still scope for improvement. More focus should be placed on self-management programmes for patients, formal education programmes for health providers, the use of multi-disciplinary teams and nurses, and electronic information systems that facilitate the easy exchange of information. Primary and secondary care systems need to be redesigned to focus more on chronically ill patients, which implies a substantial overhaul of how we think about health care. Most of the European models of chronic disease management concentrate on specific diseases rather than care as a whole. The increase in co-morbidities implies that the current models may be behind current trends, and more holistic models of primary care should be considered. This Research Note has been produced for the European Commission by Marin Gemmill from the Health and Living Conditions Network of the European Observatory on the Social Situation and Demography. The views expressed are those of the authors and do not necessarily represent those of the European Commission