Cost-of-Illness

This chapter adds the socio-economic dimension to the medical or technical perspectives of the proceeding contributions of this book. As its health economic terminology and approach might be unfamiliar to some readers, we start with a section on methodology. In particular, we present an overview of the concept of Cost-of-Illness (COI) and of relevant health economic evaluation techniques. In Sect. 2, we present the basic findings of a meta-analysis of the socio-economic costs of HIV/AIDS and of the socio-economic impact of antiviral intervention. The major findings are reflected in Sect. 3. The chapter closes with a speculation on long-term socio-economic costs of antiviral intervention. 

The studies presented in the Sect. 2 of this paper give a comprehensive picture of the Cost-of-Illness (COI) of HIV/AIDS. In a broad sense, these COI are the difference... 

In countries with an existing (social) health insurance system, it is usually rather simple do receive a close-to-reality estimate of the provider Costs-of-Illness. The insurance pays the bills of general practitioners, specialists, hospitals, pharmacies, laboratories, etc. so that the total costs per patient can easily be determined. However, in some countries we cannot receive this data, and sometimes confidentiality regulations do not permit the transfer of insurance data, so that, for instance, provider costs of difference phases of HIV/AIDS can be calculated. In this case, a sample of patient files has to be analyzed with permission of the patients so that the provider costs can be recorded. 

The calculation of indirect COI can be based on different methodologies, and there is no generally accepted standard for all circumstances. The most common approach to calculate the indirect costs of illness is the human capital method. The loss of welfare of a society in the form of nongenerated commodities and services mainly depends on the lost working hours. The method assumes that if a person had... 

Consequently, there is no golden standard of calculating indirect Costs-of-Illness. The estimates based on different methodologies might differ significantly, and so will the total Costs-of-Illness of HIV/AIDS. It is possible to analyze the quality of studies whether all components (such as indirect costs of caring relatives etc.) have been included. Whether the methodology applied is best cannot always be determined. 

Table 3 Examples of provider cost-of-illness in the HAART era [US p.a,]...

Hodgson TA, Meiners M (1979) Guidelines for Cost-of-Illness studies in the public health services. Task force on Cost-of-Illness studies, US Public Health Services, WA Holtgrave DR, Pinkerton SD (1997) Updates of Cost-of-lllness and quality of hfe estimates for use in economic evaluations of HIV prevention programs, J Acquit Immune Defic Syndr Hum Retrovirol 16 54-62... 

Rice DP (1967) Estimating the Cost-of-Illness, Am J Public Health Nations Health 57 424 440 Rice DP, Cooper BS (1967) The economic value of human Ufe, Am J Public Health Nations Health 57 1954-1966... 

Shah and Jenkins (2000) in a review of mental health economic studies from around the world identified 40 cost-of-illness studies, of which five covered all disorders, one neuroses, two panic disorders and one anxiety. All were from developed countries. There were numerous cost-effectiveness studies but none involving the anxiety disorders specifically. One study in the UK examined the cost-benefit analysis of a controlled trial of nurse therapy for neurosis in primary care (Ginsberg et al, 1984). 

Rupp A, Cause EM, Regier, DA (1998). Research policy implications of cost-of-illness studies for mental disorders. Br J Psychiatry 173 (suppl. 36), 19-25. 

The total cost of illness includes direct and indirect costs. This has been calculated as ranging from US 30 billion to 45 billion annually in the USA in the period 1990-93 (Greenberg et al, 1993 Wyatt and Renter, 1995 Rice and Miller, 1995). The total loss... 

J. A. Johnson and J. L. Bootman, Drug related morbidity and mortality a cost of illness model, Arch. Intern. Med., 55, 1949 (1995). 

F. R. Ernst and A. J. Grizzle, Drug-related morbidity and mortality updating the cost-of-illness model, J. Am. Pharm. Assoc., 41, 192 (2001). 

Johnson, J., and J. Bootman, "Drug-Related Morbidity And Mortality. A Cost-Of-Illness Model," Arch. Intern. Med., 155, 1949-1956 (1995). 

Ernst, F.R. and A.J. Grizzle, "Drug-Related Morbidity and Mortality Updating the Cost-of-Illness Model," /. Am. Pharmaceut. Assoc., 41, 192-199 (2001). 

Department of Health and Human Services, National Institutes of Health. "Disease-specific Estimates of Direct and Indirect Costs of Illness and NIH Support." (2000). wwwl.od.nih.gov/osp/ospp/ecostudies/COIreportweb.htm... 

Johnson, J.A. and Bootman, J.L. (1995) Drug-related morbidity and mortality. A cost of illness model. Archives of Internal Medicine, 155 (18), 1949-1956. 

A cost-of-illness model. Archives of Internal Medicine, 155 (18), 1949-1956. 

Libscomb J, Ancukiewicz M, Parmigiani G, Hasselblad V, Samsa G, Matchar DBJ. Predicting the cost of illness a comparison of alternative models applied to stroke. Med Decis Making 1998 18 S39-56. 

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. 

Luppa M, Heinrich S, Angermeyer MC, Konig HH, Riedel-Heller SG. Cost of illness studies of major depression a systematic review. J. Affec. Disorders. 2007 98 29-43. 

Ernst ER, Grizzle AJ. Drug-related morbidity and mortality Updating the cost-of-illness mo. J AM Pharm Assoc 2001 41 192-9. 

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