Summary: Economic Burden of Illness in Canada, 2005–2008

Summary of EBIC 2005-2008 Results

Economic Burden of Illness in Canada by Cost Type and Cost Component

In 2008, the estimated total economic burden of illness and injury in Canada, in 2010 constant dollars, was $192.8 billion, as shown in Table 1.^{Footnote 1} Direct costs accounted for $175.6 billion (91.1%) and indirect costs for $17.2 billion (8.9%) of total costs in 2008.  In 2005, the total cost estimated was $169.5 billion: $153.2 billion (90.4%) and $16.2 billion (9.6%) in direct and indirect costs respectively. Therefore, the estimates of the total Canadian economic burden of illness and injury increased 13.8% from 2005 to 2008.

Table 2 illustrates the EBIC 2005-2008 national cost estimates in current dollars, by cost type and cost component. In all years of analysis, direct costs represented a significant percentage of total costs, on average 90.8%, while indirect costs represented, on average, only 9.2%. In all years of analysis, hospital care expenditures were the largest direct cost component (with attributable expenditures) and morbidity costs were the largest indirect cost component. In 2008, hospital care, drug and physician care expenditures represented 26.0% ($49.1 billion), 14.8% ($27.9 billion) and 12.6% ($23.8 billion) of total costs respectively. Morbidity and mortality costs represented 8.7% ($16.4 billion) and 0.2% ($0.5 billion) of total costs, in 2008, respectively.

Economic Burden of Illness in Canada by Diagnostic Category and Cost Type^{Footnote 2}

Table 3 illustrates EBIC 2008 cost estimates by diagnostic category, cost type and cost component. In 2008, 50.1% ($94.6 billion of $188.9 billion) of the costs of illness and injury could be attributed by diagnostic category. The unattributable costs consisted of direct ($88.1 billion) and indirect ($6.2 billion) costs that could not be attributed by diagnostic category. Specifically, 48.8% ($83.9 billion) and 63.3% ($10.7 billion) of direct and indirect costs could be attributable to a specific diagnostic category. With the exception of the diagnostic category respiratory infections, direct costs were larger than indirect costs for all diagnostic categories.

Diagnostic Categories with the Largest Direct Costs

As illustrated in Table 3, in 2008 the five diagnostic categories with the highest total direct costs were cardiovascular diseases ($11.7 billion, 6.8%), neuropsychiatric conditions ($11.4 billion, 6.6%), musculoskeletal diseases ($5.8 billion, 3.4%), digestive diseases ($5.5 billion, 3.2%) and injuries ($5.1 billion, 3.0%).  Together, the five categories represented almost a quarter ($39.5 billion of $172.0 billion, 23.0%) of total direct costs and almost half ($39.5 billion of $83.9 billion, 47.1%) of direct costs attributable by diagnostic category.

Figure 1 shows the cost distribution by direct cost component for the five diagnostic categories with the highest total direct costs in 2008. Hospital care expenditures represented the largest percentage of direct costs for all diagnostic categories, except for the musculoskeletal diseases category. Specifically, hospital expenditures represented over 50% of direct costs of digestive diseases ($2.8 billion, 51.6%), and over 65% for injuries ($3.4 billion, 66.7%). Physician care expenditures were the most costly direct cost component in the musculoskeletal diseases category ($2.0 billion, 34.6%).

Diagnostic Categories with the Largest Indirect Costs

In 2008, as shown in Table 3, the five diagnostic categories with the highest total indirect costs were injuries ($3.0 billion, 17.8%), respiratory infections ($2.8 billion, 16.7%), musculoskeletal diseases ($1.4 billion, 8.3%), neuropsychiatric conditions ($1.0 billion, 6.2%) and certain infectious and parasitic diseases ($0.8 billion, 5.0%). Together, the five diagnostic categories represented over half ($9.0 billion of $16.9 billion, 54.0%) of total indirect costs and over 80% ($9.0 billion of $10.7 billion, 85.3%) of indirect costs attributable by diagnostic category.

Figure 2 shows the cost distribution by indirect cost component for the five diagnostic categories with the highest total indirect costs in 2008. Morbidity costs represented over 97% of indirect costs for all five diagnostic categories and represented almost 100% of indirect costs for respiratory infections ($2.8 billion, 99.8%) and musculoskeletal diseases ($1.4 billion, 99.8%). Of the five diagnostic categories, injuries showed the highest percentage of mortality costs ($0.1 billion, 2.8%).

Diagnostic Categories with the Largest Total Costs

As illustrated in Table 3, the five diagnostic categories with the highest total costs in 2008 were neuropsychiatric conditions ($12.5 billion, 6.6%), cardiovascular diseases ($12.1 billion, 6.4%), injuries ($8.1 billion, 4.3%), musculoskeletal diseases ($7.2 billion, 3.8%) and digestive diseases ($5.7 billion, 3.0%). Together, the five diagnostic categories represented almost a quarter ($45.5 billion of $188.9 billion, 24.1%) of total costs and almost half ($45.5 billion of $94.6 billion, 48.1%) of total costs attributable by diagnostic category.

Figure 3 shows the cost distribution by cost component for the five diagnostic categories with the highest total costs in 2008. Hospital care expenditures represented the largest percentage of total costs for all five diagnostic categories, except for the musculoskeletal diseases category for which it was the third largest. Physician care expenditures represented the largest percentage of total costs for musculoskeletal diseases ($2.0 billion, 27.9%). Drug expenditures were the second largest percentage for neuropsychiatric conditions ($3.6 billion, 28.5%), cardiovascular diseases ($4.3 billion, 35.4%) and digestive diseases ($1.4 billion, 25.2%). Morbidity costs accounted for the second highest costs for injuries ($2.9 billion, 36.0%).

Economic Burden of Illness in Canada by Sex

Fifty-three percent of the total cost of illness ($100.7 billion of $188.9 billion) could be attributed by sex. The unattributable costs ($88.1 billion) consisted of direct costs that could not be attributed by sex.^{Footnote 3}

Economic Burden of Illness by Sex and Cost Type

Figures 4-6 show the distribution of direct, indirect and total costs by sex. Males accounted for a lower percentage of direct costs (45.9% versus 54.1%) and a higher percentage of indirect costs (54.9% versus 45.1%) compared to females. In considering direct and indirect costs together, males accounted for a lower percentage of the burden of illness and injury than females with 47.4% and 52.6% of the burden attributed respectively.

Economic Burden of Illness by Sex and Cost Component

Figure 7 illustrates the cost distribution by sex and cost component in 2008. Total costs were lower for males ($47.8 billion) compared to females ($53.0 billion). Relative to females, costs for males comprised a larger percentage of hospital care (39.7% versus 37.7%), mortality (0.7% versus 0.2%) and morbidity (18.7% versus 14.1%), and a lower percentage of drug (20.4% versus 21.6%) and physician care (20.6%  versus 26.3%) costs.

Figure 8 illustrates the cost distribution by cost component and sex in 2008. Males accounted for a higher percentage of morbidity ($8.9 billion, 54.4%) costs.  Additionally, males accounted for over two-thirds of mortality costs ($0.3 billion, 74.0%). Females accounted for a higher percentage of hospital care ($20.0 billion, 51.3%), drug ($11.5 billion, 54.1%) and physician care ($14.0 billion, 58.7%) costs.

Economic Burden of Illness in Canada by Age Group

Fifty-three percent of the total cost of illness ($100.7 billion of $188.9 billion) could be attributed by age group.^{Footnote 4} The unattributable costs ($88.1 billion) consisted of direct costs that could not be attributed by age group.^{Footnote 5}

Economic Burden of Illness by Age Group and Cost Type

Figures 9-11 show the distribution of direct, indirect and total costs by age group. Individuals aged 35-54 years ($20.2 billion, 24.1%) and 75 years and older ($18.1 billion, 21.6%) accounted for the highest percentage of direct costs. Indirect costs were highest for individuals aged 35-54 years ($10.1 billion, 60.2%), followed by individuals aged 15-34 years ($3.8 billion, 22.5%). When direct and indirect costs are considered together, the distribution more similarly reflects that of the direct costs with individuals aged 35-54 years ($30.4 billion, 30.1%) and 75 years and older ($18.1 billion, 18.0%) accounting for the highest percentage of total costs.

Economic Burden of Illness by Age Group and Cost Component

Figure 12 illustrates the cost distribution by age group and cost component in 2008. For all age groups, with the exception of individuals aged 15-34 years and 35-54 years, hospital care expenditures were the cost component that accounted for the highest costs. Hospital care expenditures represented half of costs for individuals aged 0-14 years ($3.2 billion, 50.0%) and almost half of the costs for individuals aged 65-74 years ($6.4 billion, 48.2%); these groups all had no or very low indirect costs. Morbidity costs were the cost component with the highest costs for individuals aged 35-54 years ($9.9 billion, 32.7%). For all age groups for which mortality costs were estimated, these costs accounted for the lowest percentage of costs within each age group.

Figure 13 illustrates the cost distribution by cost component and age group in 2008. Individuals aged 75 years and older accounted for the highest percentage of hospital care expenditures ($11.5 billion, 29.4%). The highest percentage of drug ($6.4 billion, 30.0%), physician care ($6.4 billion, 26.8%), mortality ($0.2 billion, 51.8%) and morbidity ($9.9 billion, 60.5%) costs were attributable to individuals aged 35-54 years.