Economic burden studies can provide insights into the drivers leading to increasing healthcare costs. It can also provide a more holistic view of how diseases impact the welfare of patients and their families. Having concrete estimates of the economic burden across multiple diseases can help policymakers determine which diseases are economically more burdensome. This study aimed to review and summarise comprehensively economic burden studies across multiple diseases in the Nordic countries between 2000 and 2020.
Methods:
According to the 2020 PRISMA statement, a systematic literature review was conducted in PubMed, CINAHL, Academic Search Premier and Global Health databases using key terms related to the economic burden of any disease in Denmark, Finland, Greenland, Iceland, Norway and Sweden. Grey literature was also reviewed.
Results:
A total of 10,050 potential titles and abstracts were identified and screened, and 254 full-text papers that met the inclusion criteria were evaluated by two independent reviewers. Of these, 119 articles were included in a qualitative synthesis. Twenty-nine had clearly defined comparison groups, thus able to attribute the costs to the disease. Large variations concerning methodology and cost components were noted. Across diseases, the economic burden ranged from EUR 1668 per patient annually for chronic obstructive pulmonary disease to EUR 93,041 for multiple sclerosis. However, estimates varied widely, even within each disease.
Conclusions:
Our review highlights the need for more comparable economic burden studies. Future studies should focus on applying robust methodology and homogeneous cost-reporting methods to inform policymakers about which diseases are economically more burdensome.
LopezADMathersCD. Measuring the global burden of disease and epidemiological transitions: 2002–2030. Ann Trop Med Parasitol2006;100:481–99.
2.
LopezAMathersCDEzzatiM, et al. Global Burden of Disease and Risk Factors. Washington, DC: World Bank and Oxford University Press
3.
MurrayCJLopezAD. Measuring the global burden of disease. N Engl J Med2013;369:448–57.
4.
O’DonovanMRSezginDLiewA, et al. Burden of disease, disability-adjusted life years and frailty prevalence. QJM2019;112:261–7.
5.
SmithKM, et al. Infectious disease and economics: the case for considering multi-sectoral impacts. One Health2019;7:100080.
6.
World Health Organization. WHO guide to identifying the economic consequences of disease and injury. Geneva, Switzerland: World Health Organization, 2009.
7.
ChisholmDStancioleAETan Torres EdejerT, et al. Economic impact of disease and injury: counting what matters. BMJ2010;340:c924.
8.
ZhuBPangRChevallierJ, et al. Including intangible costs into the cost-of-illness approach: a method refinement illustrated based on the PM(2.5) economic burden in China. Eur J Health Econ2019;20:501–11.
de VriesLMvan BaalPHMBrouwerWBF. Future costs in cost-effectiveness analyses: past, present, future. Pharmacoeconomics2019;37:119–30.
11.
MeltzerD. Accounting for future costs in medical cost-effectiveness analysis. J Health Econ1997;16:33–64.
12.
ByfordSTorgersonDJRafteryJ. Economic note: cost of illness studies. BMJ2000;320:1335.
13.
FinkelsteinECorsoP. Cost-of-illness analyses for policy making: a cautionary tale of use and misuse. Expert Rev Pharmacoecon Outcomes Res2003;3:367–9.
14.
TarriconeR. Cost-of-illness analysis. What room in health economics?Health Policy2006;77:51–63.
15.
JoC. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol2014;20:327–37.
16.
Paz-ZuluetaMParás-BravoPCantarero-PrietoD, et al. A literature review of cost-of-illness studies on the economic burden of multiple sclerosis. Mult Scler Relat Disord2020;43:102162.
17.
KrenselMSchäferIAugustinM. Cost-of-illness of melanoma in Europe – a systematic review of the published literature. J Eur Acad Dermatol Venereol2019;33:504–10.
18.
LesyukWKrizaCKolominsky-RabasP. Cost-of-illness studies in heart failure: a systematic review 2004–2016. BMC Cardiovasc Disord2018;18:74.
19.
ChristensenMKLimCCWSahaS, et al. The cost of mental disorders: a systematic review. Epidemiol Psychiatr Sci2020;29:e161.
20.
DeeAKearnsKO’NeillC, et al. The direct and indirect costs of both overweight and obesity: a systematic review. BMC Res Notes2014;7:242.
21.
Van Der WelKAÖstergrenOLundbergO, et al. A gold mine, but still no Klondike: Nordic register data in health inequalities research. Scand J Public Health2019;47:618–30.
22.
GisslerMLouhialaPHemminkiE. Nordic medical birth registers in epidemiological research. Eur J Epidemiol1997;13:169–75.
23.
Maret-OudaJ, et al. Nordic registry-based cohort studies: possibilities and pitfalls when combining Nordic registry data. Scand J Public Health2017;45:14–9.
24.
PageMJMcKenzieJEBossuytPM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ2021;372:n71.
25.
VosTLimSSAbbafatiC, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet2020;396:1204–22.
26.
SassiFArchardLMcDaidD. Searching literature databases for health care economic evaluations: how systematic can we afford to be?Med Care2002;40:387–94.
FløeAHilbergOWejseC, et al. The economic burden of tuberculosis in Denmark 1998-2010. Cost analysis in patients and their spouses. Int J Infect Dis2015;32:183–90.
29.
Gade SikjærMHilbergOIbsenR, et al. Direct and indirect economic and health consequences related to sarcoidosis in Denmark: a national register-based study. Respir Med2019;152:7–13.
30.
RiceDPHodgsonTAKopsteinAN. The economic costs of illness: a replication and update. Health Care Financ Rev1985;7:61–80.
31.
MüllerD, et al. [Checklist for the development and assessment of cost-of-illness studies]. Gesundheitswesen2018;80:744–53.
32.
TackJStanghelliniVMearinF, et al. Economic burden of moderate to severe irritable bowel syndrome with constipation in six European countries. BMC Gastroenterol2019;19:69.
33.
HjalteFOlofssonSPerssonU, et al. Burden and costs of migraine in a Swedish defined patient population – a questionnaire-based study. J Headache Pain2019;20:65.
34.
WeidlichDAnderssonFLOelkeM, et al. Annual direct and indirect costs attributable to nocturia in Germany, Sweden, and the UK. Eur J Health Econ2017;18:761–71.
35.
SpeetsAMWolleswinkelJHForsgrenA, et al. Use of medical resources and indirect costs of otitis media in Sweden. Scand J Public Health2011;39:137–46.
36.
CardellLOOlssonPAnderssonM, et al. TOTALL: high cost of allergic rhinitis-a national Swedish population-based questionnaire study. NPJ Prim Care Respir Med2016;26:15082.
37.
HellgrenJCervinANordlingS, et al. Allergic rhinitis and the common cold – high cost to society. Allergy2010;65:776–83.
38.
SortsøCGreenAJensenPB, et al. Societal costs of diabetes mellitus in Denmark. Diabet Med2016;33:877–85.
39.
BirnbaumH. Friction-cost method as an alternative to the human-capital approach in calculating indirect costs. Pharmacoeconomics2005;23:103–4.
40.
PikeJGrosseSD. Friction cost estimates of productivity costs in cost-of-illness studies in comparison with human capital estimates: a review. Appl Health Econ Health Policy2018;16:765–78.
41.
KrolMBrouwerWRuttenF. Productivity costs in economic evaluations: past, present, future. Pharmacoeconomics2013;31:537–49.
42.
SørensenMArnebergFLineTIM, et al. Cost of diabetes in Norway 2011. Diabetes Res Clin Pract2016;122:124–32.
43.
DrummondMSculpherMClaxtonK, et al. Methods for the economic evaluation of health care programmes. 3rd ed.Oxford: Oxford University Press, 2005.
44.
LøkkeAHilbergOKjellbergJ, et al. Economic and health consequences of COPD patients and their spouses in Denmark – 1998–2010. COPD2014;11:237–46.
45.
LøkkeAHilbergOTønnesenP, et al. Direct and indirect economic and health consequences of COPD in Denmark: a national register-based study: 1998–2010. BMJ Open2014;4:e004069.
46.
LisspersKLarssonKJohanssonG, et al. Economic burden of COPD in a Swedish cohort: the ARCTIC study. Int J Chron Obstruct Pulmon Dis2018;13:275–85.
47.
LudvigssonMBernfortLMarcussonJ, et al. Direct costs of very old persons with subsyndromal depression: a 5-year prospective study. Am J Geriatr Psychiatry2018;26:741–51.
48.
SsegonjaRAlaieIPhilipsonA, et al. Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: a longitudinal cost-of-illness study. J Affect Disord2019;258:33–41.
49.
SaetterstrømBOlsenJJohansenJD. Cost-of-illness of patients with contact dermatitis in Denmark. Contact Dermatitis2014;71:154–61.
50.
NorlundAApelqvistJBitzénPO, et al. Cost of illness of adult diabetes mellitus underestimated if comorbidity is not considered. J Intern Med2001;250:57–65.
51.
JennumPSabersAChristensenJ, et al. Welfare consequences for people with epilepsy and their partners: a matched nationwide study in Denmark. Seizure2017;49:17–24.
52.
BundgaardJSMogensenUMChristensenS, et al. The economic burden of heart failure in Denmark from 1998 to 2016. Eur J Heart Fail2019;21:1526–31.
53.
KhaliliHEverhovAHHalfvarsonJ, et al. Healthcare use, work loss and total costs in incident and prevalent Crohn’s disease and ulcerative colitis: results from a nationwide study in Sweden. Aliment Pharmacol Ther2020;52:655–68.
54.
GyllenstenHWibergMAlexandersonK, et al. Comparing costs of illness of multiple sclerosis in three different years: a population-based study. Mult Scler2018;24:520–28.
55.
JennumPIbsenRKjellbergJ. Welfare consequences for people diagnosed with nonepileptic seizures: A matched nationwide study in Denmark. Epilepsy Behav2019;98:59–65.
56.
LöfvendahlSPeterssonIFTheanderE, et al. Incremental costs for psoriasis and psoriatic arthritis in a population-based cohort in southern Sweden: is it all psoriasis-attributable morbidity?J Rheumatol2016;43:640–7.
57.
NorlinJMCarlssonKSPerssonU, et al. Resource use in patients with psoriasis after the introduction of biologics in Sweden. Acta Derm Venereol2015;95:156–61.
58.
ThomsenSFSkovLDodgeR, et al. Socioeconomic costs and health inequalities from psoriasis: a cohort study. Dermatology2019;235:372–9.
59.
StrömbeckBEnglundMBremanderA, et al. Cost of illness from the public payers’ perspective in patients with ankylosing spondylitis in rheumatological care. J Rheumatol2010;37:2348–55.
60.
JennumPGyllenborgJKjellbergJ. The social and economic consequences of epilepsy: a controlled national study. Epilepsia2011;52:949–56.
61.
MunnZMoolaSLisyK, et al. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc2015;13:147–53.
62.
JanssonSAAnderssonFBorgS, et al. Costs of COPD in Sweden according to disease severity. Chest2002;122:1994–2002.
63.
BrundinLKobeltGBergJ, et al. New insights into the burden and costs of multiple sclerosis in Europe: results for Sweden. Mult Scler2017;23:179–91.
HenrikssonFAgardhCDBerneC, et al. Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med2000;248:387–96.
66.
BolinKBerggrenFLandtblomAM. Prevalence and cost of epilepsy in Sweden – a register-based approach. Acta Neurol Scand2015;131:37–44.
67.
BolinKGipCMörkA-C, et al. Diabetes, healthcare cost and loss of productivity in Sweden 1987 and 2005 – a register-based approach. Diabet Med2009;26:928–34.
68.
GyllenstenHWibergMAlexanderssonK, et al. Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age. Eur J Health Econ2018;19:435–46.
69.
HenrikssonFBergJAtherlyD, et al. Costs, quality of life and disease severity in multiple sclerosis: a cross-sectional study in Sweden. Eur J Neurol2001;8:27–35.
70.
SvedbomADahlénJMamoloC, et al. Economic burden of psoriasis and potential cost offsets with biologic treatment: a Swedish register analysis. Acta Derm Venereol2016;96:651–7.
71.
MeasePJGladmanDDPappKA, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol2013;69:729–35.
72.
HallertEHusbergMSkoghT. Costs and course of disease and function in early rheumatoid arthritis: a 3-year follow-up (the Swedish TIRA project). Rheumatology (Oxford)2006;45:325–31.
73.
HastrupLHSimonsenEIbsenR, et al. Societal costs of schizophrenia in Denmark: a nationwide matched controlled study of patients and spouses before and after initial diagnosis. Schizophr Bull2020;46:68–77.
74.
EvensenSWisløffTLystadJ, et al. Prevalence, employment rate, and cost of schizophrenia in a high-income welfare society: a population-based study using comprehensive health and welfare registers. Schizophr Bull2016;42:476–83.
75.
SopinaESpackmanEMartikainenJ, et al. Long-term medical costs of Alzheimer’s disease: matched cohort analysis. Eur J Health Econ2019;20:333–42.
76.
HicksonK. The GDP value of twentieth-century health improvements in developed economies: initial estimates for England. Rev Income Wealth2014;60:385–99.
77.
GustavssonASvenssonMJacobiF, et al. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol2011;21:718–79
78.
SolliOJenssenTKristiansenIS. Diabetes: cost of illness in Norway. BMC Endocr Disord2010;10:15.
79.
KruseMChristiansenT. Register-based studies of healthcare costs. Scand J Public Health2011;39:206–9.
80.
JanssonSALindbergAEricssonA, et al. Cost differences for COPD with and without physician-diagnosis. COPD2005;2:427–34.
81.
JanssonSABackmanHStenlingA, et al. Health economic costs of COPD in Sweden by disease severity – has it changed during a ten years period?Respir Med2013;107:1931–8.
82.
SobockiPLekanderIBorgströmF, et al. The economic burden of depression in Sweden from 1997 to 2005. Eur Psychiatry2007;22:146–52.
83.
EkmanMJohnellOLidgrenL. The economic cost of low back pain in Sweden in 2001. Acta Orthop2005;76:275–84.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
