Economy and diseases: the prognosis is unfavorable

Diabetes mellitus, malignant neoplasms and cardiovascular diseases: what awaits us in the future?

Evgenia Lukyanchuk, "Weekly Pharmacy" www.apteka.ua

Even 60-70 years ago, the world community was greatly concerned about the increase in the prevalence of infectious diseases, but now they have managed to cope with them and other problems have come to the fore. Diabetes mellitus, cardiovascular diseases, malignant neoplasms and other non-communicable diseases are the main cause of mortality among the able-bodied population and their prevalence continues to increase steadily. Non-communicable diseases not only cause irreparable harm to health, but also have a negative socio-economic impact. Currently, more and more public organizations and governments of countries regard the increase in the incidence of non-communicable pathology as a dangerous medical and social problem and one of the main threats to the growth of the world economy.

Non-communicable diseases are characterized by a long course, slow progression and non-infectious nature. They are the leading cause of death among adults worldwide. In terms of such indicators as morbidity and mortality, 4 main groups can be distinguished among non-communicable diseases: cardiovascular, chronic respiratory diseases (including chronic obstructive pulmonary disease and asthma), diabetes mellitus, malignant neoplasms. In addition, schizophrenia, bipolar depressive disorders and other mental disorders are a major medical and social problem, which also make a significant contribution to the financial losses associated with non-communicable diseases. It is the prevalence and costs of treating these diseases, as well as the associated costs, that will be the focus of further attention. However, to complete the picture, it should also be noted the important importance of disorders such as glaucoma, hearing loss, diseases of the digestive system (for example, cirrhosis of the liver), systemic diseases affecting the musculoskeletal system (rheumatoid arthritis, gout), which have a negative impact on the quality of life of patients and cause an increase in health care costs in general. In addition, these diseases also impose certain restrictions both in everyday life and in work.

According to research conducted by the World Bank, it is expected that by 2030, 75% of the costs associated with various diseases (including direct, indirect costs and lost income) in middle-income countries per capita will be non-communicable diseases. For comparison, in 2010 this indicator was estimated at 66%. About 63% of deaths worldwide are the result of the development of these diseases. Of these, 45% of deaths were caused by cardiovascular diseases, 21% by malignant tumors, 12% by chronic respiratory diseases and 3% by diabetes mellitus. At the same time, countries with low per capita income accumulate 80% in the structure of global expenditures related to non-communicable diseases (direct treatment costs, indirect costs and lost income). By 2030, mortality from non-communicable diseases is expected to increase by 50% in middle- and low-income countries per capita.

Expected global economic impactsDespite the fact that at present the consequences of the increase in the prevalence of noncommunicable diseases have not yet reached a peak, economists are increasingly concerned that this process in the long term may have a significant negative impact on macroeconomic indicators such as GDP and the rate of capital accumulation, as well as on labor resources.

At the same time, although these consequences will affect the economies of most countries of the world, the strongest impact will be on developing economies (Mayer-Foulkes, 2011; Nikolic, Stanciole, Zaydman, 2011).

Worldwide, a reduction in the number of able-bodied population due to increased mortality due to non-communicable diseases and an increase in direct costs for their therapy lead to a decrease in labor resources and accumulated capital. So, in the USA, men with chronic non–communicable diseases worked by 6.1%, and women - by 3.9% less compared to healthy people. In addition, according to studies conducted in the United States, a healthy lifestyle of the population contributes to a 49% reduction in health care costs among people under the age of 40 (Mayer-Foulkes, 2011). In particular, obesity leads to an increase in individual treatment costs by 36%, smoking – by 21%, alcohol consumption – by 10%. It should be noted that all 3 of the above factors play a leading role in increasing the risk of developing non-communicable diseases.

In addition, according to other studies in the EU, non-communicable diseases, especially in men, increase the likelihood of early retirement, and in Russia, a patient with a chronic non-communicable disease earns an average of 5.6% less compared to healthy people (Suhrcke, 2006; Mayer-Foulkes, 2011).

Malignant neoplasmsMalignant neoplasms occupy the 2nd position in the structure of mortality from non-communicable diseases in the world.

Risk factors for the development of malignant tumors are genetic characteristics, smoking, alcohol consumption, low physical activity, poor nutrition, past infections, environmental characteristics.

According to the data published by the World Economic Forum and the Harvard School of Public Health in the report "The Global Economic Burden of Non-communicable Diseases, 2011", it is expected that in 2030 the number of newly diagnosed malignant neoplasms will increase to 21.5 million. For comparison, this figure in 2010 was at the level of 13.3 million cases. In 2010, lung cancer (12.8%), breast cancer (10.9%), colorectal cancer (9.8%), stomach cancer (7.8%) and prostate cancer (7.1%) retained the largest share among malignant neoplasms in the world (Fig. 1). It should be noted that the prevalence of lung cancer breast and stomach were approximately the same in the countries, regardless of the level of income per capita (Fig. 2, 3). However, this situation is not typical for all localizations. For example, the share of cervical cancer in low–income countries per capita is 12%, while in high-income countries it is only 1%.

Fig. 1. The number of diagnosed cases of malignant neoplasms in the world for the top 5 most common forms of cancer, indicating their share in the structure of the total incidence of oncological pathology in 2010 and the forecast for 2030.
The source of this and all other figures is the report "The Global Economic Burden of Non-communicable Diseases, 2011", published by the World Economic Forum and the Harvard School of Public Health.

Fig. 2. The number of diagnosed cases of malignant neoplasms in countries with low per capita income for the top 5 most common forms of cancer, indicating their share in the structure of the total incidence of oncological pathology in 2010 and forecast for 2030.

Fig. 3. The number of diagnosed cases of malignant neoplasms in countries with high per capita income for the top 5 most common forms of cancer, indicating their share in the structure of the total incidence of oncological pathology in 2010 and forecast for 2030.

The incidence of malignant neoplasms in proportion remains stable, and the growth of this indicator in absolute terms is due to the overall increase in the number of the world's population. However, these forecasts do not take into account possible achievements in the development of new more effective methods of treating malignant neoplasms, which may appear before 2030.

It is expected that the cost of treating new cases of malignant tumors diagnosed in 2030 will amount to $458 billion, which is $168 billion more than in 2010. (Fig. 4). It should be noted that in 2010 the United States accumulated the largest share in the structure of expenditures for the treatment of malignant neoplasms – 53% ($ 154 billion). At the same time, indirect costs associated with this disease were at the level of $ 67 billion, and the amount of lost income was $69 billion.

Fig. 4. Expenses related to the incidence of malignant neoplasms for the top 5 most common forms of cancer in the world in 2010 and forecast for 2030

Cardiovascular diseasesAmong cardiovascular diseases, ischemic heart disease and stroke are of the greatest socio-economic importance.

In addition, significant costs are associated with such a complication as heart failure. Cardiovascular diseases lead to early disability or death, and their treatment requires significant costs. About 82% of deaths from these diseases are associated with coronary heart disease, strokes, hypertension and heart failure. Over the past 10 years, cardiovascular diseases have been the leading cause of death in the world, accumulating 30% of all deaths and 45% of deaths from non-communicable diseases. The cause of almost 80% of cardiovascular diseases is insufficient physical activity, smoking and poor nutrition (Gaziano et al., 2010).

The main items of expenditure in this case are the costs of hospitalization, medical care for a long period. In addition, due to partial or complete disability, the volume of lost income and indirect costs associated with these diseases increases. It is also necessary to take into account the funds spent on the prevention of cardiovascular diseases.

Taking into account all the above expenses, in 2010 the volume of costs associated with cardiovascular diseases is estimated at $863 billion (Fig. 5). At the same time, on average, $125 per capita is accounted for. It is expected that by 2030, the cost of treating these diseases will increase by 22% and exceed $1 trillion. At the same time, according to non-optimistic forecasts, the global costs associated with cardiovascular diseases, including their treatment, prevention, indirect costs and lost income, may reach $20 trillion or $3,000 per capita by 2030. It should be noted that the share of direct costs for the treatment of these diseases in 2011 amounted to 55% of the total costs associated with cardiovascular diseases.

Fig. 5. The number of diagnosed cases of some cardiovascular diseases and the costs associated with them in 2010 and the forecast for 2015-2030.

In the regional context, it should be noted that low mortality from cardiovascular diseases is observed in such regions with high per capita income as Europe and North America, and, on the contrary, high mortality rates are characteristic of countries with low per capita income.

Chronic respiratory diseasesAlong with asthma, chronic obstructive pulmonary disease has acquired the greatest socio-economic importance in recent years.

At the same time, it is expected that the global costs associated with this disease will more than double by 2030 and reach $4.8 trillion (Figure 6). It should be noted that about half of these costs will be incurred by the economies of developing countries.

Figure 6. Costs associated with the increase in the incidence of chronic obstructive pulmonary disease in 2010  and the forecast for 2030 .

Diabetes mellitusDiabetes mellitus is characterized by high mortality worldwide at the level of 1.3 million people annually.

In addition, diabetes mellitus is the cause of early disability and mortality due to concomitant diseases.

The problem of diabetes affects a huge number of people around the world. At the same time, it is expected that in the next few years there will be a tendency to a sharp increase in the number of newly diagnosed cases of this pathology.

It is expected that in 2030, the cost of diabetes treatment will reach $ 745 billion, of which the lion's share is accumulated by developing countries (Fig. 7, 8). For comparison, in 2010, this figure was at the level of $ 500 billion. At the same time, most of the expenses are direct. More than 50% of global expenses related to diabetes are recorded in the USA. In countries with high per capita income, 90% of expenses are associated with this pathology, while only 26% of the total number of patients with diabetes mellitus live there. 40% of patients with diabetes mellitus live in low- and lower-middle-income countries per capita, and their expenses account for 1.7% of the total direct global costs associated with this disease.

Fig. 7. Expenses related to diabetes mellitus per patient with this pathology in countries with different per capita income in 2010 and forecast for 2030.

Figure 8. Costs associated with diabetes mellitus, the incidence of this pathology in 2010 and the forecast for 2030.

According to forecasts, by 2030 the share of indirect costs associated with diabetes will increase significantly. A change in the redistribution of expenditures is also expected in the regional context. Thus, spending will increase in middle-income countries per capita. At the same time, expenditures in low-income countries, where 45% of patients with diabetes live, will reach $ 300 billion.

Mental disordersMental disorders are the main reason for the loss of healthy years of life.

Thus, according to data published by WHO in 2011, mental disorders accumulate 37% of healthy years of life lost from non-communicable diseases (taking into account premature mortality and period of disability). The greatest damage is caused by depressive disorders, alcoholism, schizophrenia, which lead to early disability of the population.

It should be noted that developed countries such as the United Kingdom, the United States and Australia spend significant financial resources to solve this problem. In addition, less than 70% of all WHO member countries implement mental health programs, and even fewer countries allocate funds for the treatment of these diseases within the budgets of national health systems.

According to WHO estimates, 25% of all patients using the services of medical institutions have at least one mental, neurological or behavioral disorder. At the same time, most of these diseases are not diagnosed, and patients do not receive appropriate treatment. In addition, there is a relationship between the development of mental disorders and other chronic diseases. Along with the lack of a developed system for diagnosing mental illnesses and state programs for their treatment, there are certain social prejudices that prevent the timely treatment of mental disorders. According to WHO estimates, in most low- and middle-income countries per capita, less than 1% of the state health budget will be allocated to providing medical care to patients with mental disorders.

It is expected that in 2030, the global costs associated with mental disorders will increase by more than 2 times compared to 2010 and reach $6 trillion (Figure 9). At the same time, more than 2/3 of this amount will be indirect costs, and the remaining 1/3 will be direct treatment costs. Countries with high per capita income in 2010 accumulated 65% of expenses related to mental disorders. It is expected that this indicator will not change significantly in 2030.

Fig. 9. Expenses related to mental disorders in 2010 and forecast for 2030

It is cheaper to warn than to treatThe main risk factors for the development of non-communicable diseases are poor nutrition, insufficient physical activity, smoking, alcohol consumption.

Maintaining a healthy lifestyle can significantly reduce the likelihood of developing these diseases. Therefore, propaganda aimed at reducing the number of people at risk is one of the most important tasks for Governments, the successful implementation of which will not only improve the quality of life of the population, but also improve economic indicators.

For example, according to research conducted by World Bank, in 2010 there were about 580 million people in China with at least one risk factor for the development of non-communicable diseases. And if over the next 30 years, every year in China to reduce mortality from cardiovascular diseases by 1%, it will save 68% of the country's GDP in 2010 ($ 10.7 trillion). In India, the costs associated with non-communicable diseases reduce the country's GDP by 4-10%. Financial losses are noted not only at the national level, but also at the individual level. For example, the probability of employment of patients with chronic non-communicable diseases in Egypt is 25% lower, on average they work 22 hours a week.

In light of the growing concern about the increase in the prevalence of non-communicable diseases, WHO has developed measures to reduce this indicator by spending relatively small financial resources on these activities. Thus, the cost of such measures for countries with average per capita income ranges from 1.5-4.5 dollars per capita. It should be noted that, for example, for Brazil, this amount is 0.39% of the health budget in 2010, the same indicator for India is estimated at 3.38%, for Russia, China and Mexico – 0.85%.

P.S.
Already, the costs associated with non-communicable diseases are very high and, depending on the nosological form, range from hundreds of billions to trillions of dollars per year. According to forecasts, their growth will continue mainly due to an increase in the population and its aging. In addition, the population's exposure to risk factors for the development of non-communicable diseases will increase.
It should be noted that the losses caused by a decrease in labor productivity due to disability or an increase in the mortality rate among the able-bodied population accumulate a significant share of the costs associated with non-communicable diseases. Since most non–communicable diseases are chronic, such patients need medical care for a long period, they are characterized by early disability, as well as premature retirement. At the same time, the strength of the influence of various non-communicable diseases on the state of the workforce varies significantly.

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26.01.2012