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

Introduction

The Economic Burden of Illness in Canada (EBIC) is a comprehensive cost-of-illness study that provides estimates of the burden of illness and injury by cost type, cost component, diagnostic category, sex, age group and province/territory. The primary goal of EBIC is to supply objective and comparable information on the magnitude of the economic burden or cost of illness and injury in Canada based on standard reporting units and methods.  EBIC is the only comprehensive Canadian cost-of-illness study that provides comparable costing information for all major illnesses.  Supplementing other health indicators, EBIC provides important evidence to support public health policy and program planning.

Health Canada published the first edition of the Economic Burden of Illness in Canada, 1986 (EBIC 1986), in the year 1991; subsequently, the Economic Burden of Illness in Canada, 1993 (EBIC 1993) and the Economic Burden of Illness in Canada, 1998 (EBIC 1998) were published in 1997 and 2002 respectively (1-3). An unpublished version, the Economic Burden of Illness in Canada, 2000 (EBIC 2000), was also completed (4). Responsibility for the production of EBIC was transferred to the Public Health Agency of Canada (PHAC) after creation of the organization in 2004. The demand for current cost-of-illness information along with the positive feedback associated with previous EBIC reports contributed to the decision to complete a new edition, the Economic Burden of Illness in Canada, 2005-2008 (EBIC 2005-2008).  The EBIC 2005-2008 report and its complementary web-based tool offer Canadian cost-of-illness estimates by EBIC categories (diagnostic category, sex, age group and province/territory).

For EBIC 2005-2008, a prevalence-based approach was used to estimate all costs. A prevalence-based cost-of-illness study estimates the total cost of a disease incurred in a given year regardless of the date of disease onset.

The EBIC 2005-2008 report includes estimates for direct and indirect costs; for intangible costs, such as pain and suffering, estimates are not provided. Direct costs refer to health care expenditures for which the primary objective was to improve and prevent the deterioration of health status. Three direct cost components were estimated in this report: hospital care expenditures, physician care expenditures and drug expenditures.  Other direct health expenditure totals, comprising other institutions and additional direct health expenditures (e.g. other professionals, capital, public health and other health spending), were included in the report but could not be attributed by EBIC categories. The Canadian Institute for Health Information’s (CIHI) National Health Expenditure Database (NHEX) was used to obtain all direct cost component totals (5). Total EBIC direct expenditures are compared with NHEX totals to calculate the amount of expenditures not attributable by EBIC categories.

Indirect costs refer to the dollar value of lost production due to illness, injury or premature death. In this report, only the value of lost production due to an individual’s “own” illness, injury or premature death associated with time away from labour market activities was considered (costs associated with presenteeism, non-labour market activities and informal caregiving were not included). The indirect cost components estimated in this report are the value of lost production due to premature mortality and the value of lost production due to morbidity. In previous editions of EBIC, indirect costs (mortality and morbidity costs) were estimated using the human capital method. For EBIC 2005-2008, on the basis of feedback from international experts who attended the 2009 and 2010 EBIC Workshops (organized by PHAC), the friction cost method was adopted to estimate indirect costs. This method does not assume full employment and considers lost production to occur only from the time an individual leaves his or her job as a result of illness, injury or premature death until the job vacancy is filled. The change in methods is further discussed in the individual indirect cost component reports.

Cost estimates were assigned to the most responsible health conditions, and almost all cost component estimates could be attributed to an International Classification of Diseases (ICD) code, either version 9 (ICD-9) or version 10 (ICD-10), depending on the data source. The one exception was the value of lost production due to morbidity, which utilized surveyed period of lost production estimates by broad health condition categories. The EBIC estimates attributable to an ICD code were further grouped into 24 diagnostic categories and 165 subcategories. The ICD code groupings are described in Appendix C and are largely based on the Global Burden of Disease study's groupings (6).

The EBIC 2005-2008 age groups are 0-14 years, 15-34 years, 35-54 years, 55-64 years, 65-74 years and 75 years and older. EBIC 1998 included only four age groups: 0-14 years, 15-34 years, 35-64 years and 65 years and older. The inclusion of additional age groups in EBIC 2005-2008 allows for more detailed analysis of the economic burden of illness and injury patterns given that individuals between the ages of 35 to 64 years and individuals aged 65 years and older likely have very different cost-of-illness magnitudes and distributions. On the basis of assumptions regarding labour market participation, mortality and morbidity costs were estimated only for individuals aged 15-64 years and 15-75 years respectively; please consult the appropriate indirect cost component reports for further information.

The EBIC 2005-2008 estimates should be considered in the context of the limitations described earlier and of those identified in each of the individual cost component reports. In general, comparisons of the EBIC 2005-2008 results with those of previous EBIC editions are not recommended. Differences between results may reflect improved or alternative data sources and/or changes and/or refinements to methods rather than actual differences in the magnitude and distribution of the economic burden of illness and injury. There may also be minor differences between the current years of analysis; please consult the individual cost component reports for further information.

The remainder of the report presents a summary of the EBIC 2005-2008 estimates and individual cost component reports. Each cost component report provides a background, description of the data sources and methods used, high-level results and an explanation of the assumptions and limitations that may affect the interpretation of results. While analysis has been conducted for 2005-2008, certain cost components include additional years.  For example, estimates for hospital care expenditures and the value of lost production due to premature mortality have been completed for 2004-2008, as data were available.  Estimates for the value of lost production due to morbidity have been completed for 2005-2010, as estimates are based on 2010 labour market missed work days. Appendices for abbreviations, definitions and the ICD code groupings used in the report are found at the end of the document.