Burden of illness

Gray AM, Fenn P (1993). Alzheimer s disease the burden of illness in England. Health Trends 25,31-7. 

Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics. 2004 22 (suppl 2) 1—12. 

Cost-of-illness analysis involves identifying all the direct and indirect costs of a particular disease or illness from a particular perspective (e.g., patient, payer, or society). This method, often referred to as burden of illness, results in a total cost of a disease that can be compared with the cost of implementing a prevention or treatment strategy. 

Approximately a third of stroke survivors are functionally dependent at one year and stroke is the commonest cause of neurological disability in the developed world (Murray and Lopez 1996 MacDonald et al. 2000). Stroke also causes secondary medical problems, including dementia, depression, epilepsy, falls and fractures. In the UK, the costs of stroke are estimated to be nearly twice those of coronary heart disease (British Heart Foundation Statistics Database 1998 Rothwell 2001), accounting for about 6% of total National Health Service (NHS) and Social Services expenditure (Rothwell 2001). As the population ages over the coming two decades, the total stroke rate will probably increase unless there are substantial decreases in age- and sex-specific incidence (Rothwell et al. 2004a). Stroke deaths are projected to increase from 4.5 million worldwide in 1990 to 7.7 million in 2020, when stroke will account for 6.2% of the total burden of illness (Bonita 1992 Sudlow and Warlow 1997 Menken et al. 2000). 

Voetsch AC, Van Gilder TJ, Angulo FJ, Farley MM, Shallow S, Marcus R, Cieslak PR, Deneen VC, Tauxe RV (2004) FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States. Clin Infect Dis 38(Suppl 3) S127-S134... 

The GFR cutoff values in the NKF-K/DOQI guidelines have been selected on limited data with respect to the relationship between complications and level of GFR. Further studies may refine these values. Nevertheless there is often a causal relationship between the burden of illness and the severity of CKD (see Table 45-6). 

If adequate baseline measures do not exist, then an important part of the strategic plan will be to research and document the baseline burden of illness as it is currently being treated (or not treated, if this is the case). This can be done separately from the clinical trials that are taking place, although placebo-treated patient measures may also be... 

Table 23.2 Considerations when documenting baseline burden of illness...

A study to document the outcomes of epilepsy treatment, conducted by Hirsch and Van Den Eeden (1997), illustrates some of the challenges associated with collecting burden of illness data. The traditional clinical measure of seizure frequency is no longer considered appropriate as the sole measure of outcome of treatment or surgical intervention. The additional variables to document the burden of illness that were found illustrate the gap between the type of data desired and what is available. Hitherto, QOL had been assessed in epilepsy patients using no fewer than 12 different... 

When setting out to document the burden of illness, it is critical to ensure that the patients in the databases really are patients with the disease. In some cases, the ICD-9 codes are known to be inaccurate regarding patient capture, and means other... 

Pharmacoeconomic baseline data should not be considered in isolation, but as one aspect of data that must be considered as a part of the whole. Once the burden of illness information is collected and analyzed, the development team must move to plan for ways to measure and document the clinical, economic and humanistic impact of the new pharmaceutical entity or other intervention. 

The issue of quality health care has become an increasing issue of concern in the face of cost constraints and limited access to health care. The President s Advisory Commission on Consumer Protection and Quality in the Health Care Industry (32) states that the purpose of the health care system must be to continuously reduce the impact and burden of illness, injury and disability and to improve the health and functioning of the people of the U.S. According to the Commission, there are basic characteristics of health care that, as a nation, we should strive to achieve. The Commission has created Guiding Principles for the Consumer Bill of Rights and Responsibilities for the health care of people in the United States. These include the following ... 

A cost-of-illness (COI) evaluation identifies and estimates the overall cost of a particular disease for a defined population. This evaluation method is often referred to as burden of illness and involves measuring the direct and indirect costs attributable to a specific disease. The costs of various diseases, including peptic ulcer disease, mental disorders, and cancer, in the United States have been estimated. 

Chawla A, Swindle R, Long S, et al. Premenstrual dysphoric disorder Is fliere an economic burden of illness Med Care 2002 40 1101—1112. 

Several U.S. population-based studies have estimated the prevalence of acute GI infections and the burden of illness resulting from acute diarrhea. Based on these studies, the estimates hy the Centers for Disease Control and FYevention (CDC) suggest that 211 million episodes of acute gastroenteritis occur each year in the United States, resulting in over 900,000 hospitalizations and over 6000 deaths. Although infectious diarrhea in the United States is often self-hmited, the economic burden of GI infections still remains enormous. 

Table 19.2 lists some of the important questions to consider when documenting the baseline burden of illness. Answers will not be available for every... 

The information generated from the burden of illness component of a pharmacoeconomic strategy will serve as a useful guide for the design of pharmacoeconomic components within clinical trials. Obviously, this must be factored against the prior judgment of whether or not disease-specific quality of life instruments are required at all. Healthcare resource use, measures of lost productivity, and indirect financial cost measures may be all that is required. 

It is thus in the interest of government, pan-government, and nongovernment organizations to support the development of new drugs and formulations to reduce the economic burden of ill health on individuals and on the organizations themselves. 

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