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Top 10 Most Expensive Chronic Diseases for Healthcare Payers

The top 10 most expensive chronic diseases for healthcare payers eat up significant healthcare dollars.

Top 10 most expensive chronic diseases for healthcare payers

Source: Thinkstock

By Thomas Beaton

- Chronic diseases are on the rise in the United States, leaving healthcare payers with the challenge of covering care for patients with these expensive, long-term conditions.

Chronic diseases are such a costly healthcare endeavor that experts such as the AMA have asked private and public payers to fund chronic disease management programs, and other stakeholders have established chronic disease management funds that provides Medicare beneficiaries financial support to pay for the high costs of chronic care and treatment.

Healthcare spending reached a total of $3.2 trillion dollars in 2015, based upon estimates from CMS. Spending is expected to continue to grow at an average of 5.5 percent through 2025, with chronic diseases treatment comprising a major portion that spending.

Based on the latest data from the CDC and presented in descending order, here are the top 10 most expensive chronic diseases for healthcare payers to treat.

Cardiovascular diseases

The costs of cardiovascular diseases (CVDs) in the US total $317 billion per year, split between $193.7 billion in direct medical costs and $123.5 billion in lost productivity.

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The sheer volume of patients that experience CVD fatalities is an ever-growing concern for payers. According to the CDC, an adult dies from a CVD related health condition such as a heart attack every 40 seconds. These deaths account for 31 percent of all US deaths each year.

CVD treatment accounts for roughly one dollar of every $6 spent on healthcare in the country.

Smoking-related health issues

Estimated costs for smoking-related health issues in the US total over $300 billion per year, split between direct healthcare expenses of $170 billion and indirect costs of roughly $156 billion.

Nearly 60 percent of the US population lives under laws that protect non-smokers from secondhand smoke and tobacco exposure because of associated health risks of smoking. Smokers can develop problematic chronic conditions such as cancers, high blood pressure, and cardiac health concerns.

While the CDC has established protocols to help health systems mitigate smoking risk, payers should consider offering their beneficiaries tobacco cessation programs. Payers should also be supportive of provider-based intervention strategies.

Alcohol-related health issues

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In 2010, excessive alcohol use cost the US economy $249 billion, or roughly $2.05 per drink. Alcohol-related deaths totaled 88,000 people per year and shortened the lives of working adults by an average of 30 years.

Like smoking, alcohol-related health concerns stem from socialized behaviors, and can be improved by provider interventions supported by payers. Excessive alcohol use is known to cause liver cancer, high blood pressure, and other chronic conditions.

Diabetes

As one of the most prevalent chronic conditions in healthcare, diabetes care cost $245 billion in 2016. Seventy-one percent of diabetes treatment costs ($176 billion) were related to direct healthcare expenses. That equates to 20 percent of US healthcare spending.

In the US, 29 million Americans are known to be living with diabetes and another 86 million live with prediabetes. As the seventh-leading cause of death in the US, diabetes can lead to various health complications such as blindness, kidney disease, amputations, and heart disease. Payers have to be confident and ready to cover diabetic patients by supporting public education and other provider initiatives to treat diabetics.

Alzheimer's disease

In 2016, about 15.9 million Americans provided 18.1 million hours of unpaid care to friends and family with Alzheimer's and related dementia. Based on CDC estimates, that amount of unpaid care is valued at  $223.1 billion.

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In addition, direct healthcare expenses for providing Alzheimer’s patients with long-term and hospice care cost $236 billion in 2016 alone. The disease affects 5.4 million Americans and is the sixth leading cause of death in the country.

Cancer  

According to the latest estimates from the CDC and the National Cancer Institute, cancer care costs roughly $171 billion a year due to inflation over years

Even though cancer rates are decreasing, the CDC predicts that cancer will be the leading cause of death in the US by the year 2020. Every year, 1.5 million Americans are diagnosed with some form of cancer and another 500,000 die from the disease.

Promoting early screenings, building awareness about preventative techniques, and developing strategic partnerships remain the most effective measures for cancer prevention.

Obesity

The United States spends $147 billion on healthcare related to obesity and roughly $117 billion on costs related to inadequate physical activity. In 2006, the healthcare costs of obese patients were $1,429 higher than patients at a normal weight. Obesity is implicated in the development or worsening of many other chronic conditions, including diabetes and heart disease.

Public health initiatives such as education, promoting access to healthier foods, and delivering preventive care to pediatric patients can help to keep patients at a healthy weight.

Arthritis

The total cost of arthritis in the US was an estimated $128 billion, split between $81 billion in direct medical expenses and $47 billion in related losses of productivity and care management.

Arthritis affects 23 percent of adults in the US, or 54 million people, and is expected to rise to78 million cases by 2040. Arthritis also occurs with other chronic conditions as many patients are unsure on how to manage their own symptoms.

Linking clinical services to community programs is an effective strategy for dealing with arthritic patients and mitigating other health risks.

Asthma

Asthma care in the US has an economic impact of $56 billion from direct medical costs as well as losses in work productivity and school absences. About 1 in 12 Americans, or 25 million people, have asthma.  Half of all asthma patients have suffered from an asthma attack.

The cost of asthma per individual in the US was roughly $3,300 dollars in 2003, and costs have been rising since that year.

CDC recommends that payers and employers promote healthy workspaces, provide reimbursement for long-term control medicines, and eliminate barriers to asthma attack prevention such as removing co-pays for inhaled corticosteroids and other prescribed medicines.

Stroke

On its own, stroke in the US creates medical expenses of $33 billion annually and accounts for 1 out of 20 deaths in the country, or an estimated 130,000 deaths per year.

Stroke is also more likely to recur in patients who already had one, and is the leading cause in the country of long-term disability. Usually an offshoot of other chronic conditions such as high blood pressure or cholesterol, stroke is preventable through provider intervention and education for patients at higher risk of stroke.

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