Economic Burden of Disease

EBD Basics - Counting the Cost

• Economic Burden of Disease (EBD): Quantifies total economic loss to society from a disease or health condition; measures impact on resources & productivity.
• Core Components:
  • Direct Costs: Medical care expenditures (e.g., treatment, drugs, hospitalization, diagnostics, fees).
  • Indirect Costs: Productivity losses due to morbidity (absenteeism, presenteeism) & premature mortality (lost future earnings).
  • Intangible Costs: Non-monetary impacts like pain, suffering, stigma, reduced quality of life (QoL); challenging to quantify.
• Significance in India: Crucial for health policy formulation, efficient resource allocation, and prioritizing public health interventions & research.

⭐ Indirect costs (e.g., lost productivity from morbidity and premature mortality) often constitute the largest proportion of the total EBD for many chronic diseases and non-communicable diseases (NCDs).

Cost Categories - The Price Tag Deep Dive

• Economic burden of disease is measured using distinct cost categories:

Measurement Methods - Sizing Up Sickness

• Goal: Quantify disease economic impact.
• Key Approaches:

• Cost of Illness (COI):

  • Measures: Direct (medical, non-medical) & Indirect (productivity loss) costs.
  • Types:
    • Prevalence-based: Cost of existing cases in a period.
    • Incidence-based: Lifetime cost of new cases.
  • Pros: Tangible, widely used.
  • Cons: Undervalues non-market losses.

• Human Capital Approach (HCA):

  • Measures: Value of lost productivity/earnings from illness/death. $V = E \times T$.
  • Pros: Simpler, data often available.
  • Cons: Ethical bias (age, employment), ignores intangibles.

• Willingness-to-Pay (WTP):

  • Measures: Amount individuals would pay for health risk reduction.
  • Pros: Includes intangible costs (pain, suffering).
  • Cons: Hypothetical, income-dependent, complex to measure.

⭐ COI is the most common method for EBD studies in India, focusing on direct and indirect costs.

Indian Impact & Policy - Rupee Realities

• Major Disease Burdens (India):
  • TB: High OOP, catastrophic costs (20-30% income).
  • NCDs (Diabetes, CVDs): ↑ costs, productivity loss; >60% deaths.
  • Mental Health: High indirect costs (lost workdays).
  • RTAs: High EBD, affects young adults.
• Key Findings & Data:
  • High OOP: ~48.2% Total Health Expenditure (NHA 2019-20). Drives poverty.
  • Indirect costs (morbidity, mortality) often > direct costs.
• Challenges in EBD Assessment:
  • Data gaps, regional variations.
  • Valuing intangible costs (e.g., DALYs) difficult.
• Policy Implications & Actions:
  • ↑ Public health spending (target 2.5% GDP).
  • Strengthen primary care; UHC (Ayushman Bharat PM-JAY).
  • Preventive strategies for NCDs.

⭐ Catastrophic Health Expenditure (CHE) occurs when OOP health spending exceeds 10% of total household expenditure or 40% of non-food expenditure.

High‑Yield Points - ⚡ Biggest Takeaways

• EBD quantifies total economic loss (direct & indirect costs) from disease.
• DALYs = YLL + YLD; 1 DALY = 1 lost healthy year. Key EBD metric.
• Cost of Illness (COI) studies (prevalence/incidence-based) estimate EBD.
• Indirect costs (lost productivity) are often the largest EBD share.
• EBD data informs health policy, resource allocation, & intervention priorities.
• Catastrophic Health Expenditure: OOP spending > 10-25% household income.
• India: High EBD from communicable & non-communicable diseases (NCDs rising).