Most Expensive Diseases

      One way to reduce health care costs would be to find diseases with the most rapidly rising costs and target them for cuts. Unfortunately, the costs for treating pretty much every disease are growing rapidly–and for a bewildering variety of reasons.

In the effort to overhaul America’s health care system and the associated costs, this is not welcome news.

It isn’t just the high-profile, often terminal ailments that are getting pricier to treat. Sure, costs for treating diseases like colon cancer are growing because fancy new drugs make each case much more expensive (drugs such as Erbitux for colon cancer can cost well over $50,000 per year). Simple, everyday problems cost more to treat too. Diseases like heartburn and high cholesterol are getting more expensive because more people are being treated. Total medical costs grew at a 7% rate between 1996 and 2005.

Most-expensive-diseases list

The list of the 10 most expensive diseases are Roehrig’s estimates, based on 2005 data, and is purportedly the most accurate compilation of disease-by-disease health costs to date. Previous government surveys included community-dwelling patients using data from the federal Medical Expenditure Panel Survey. Roehrig’s estimate, however, provides a fuller picture by also accounting for costs of treating patients in nursing homes, the military, prisons and mental hospitals.

Nursing-home expenses explain why spending on mental health disorders such as depression, anxiety and Alzheimer’s disease rise to the top of the list. They accounted for $142.2 billion in spending, vs. $123 billion of spending on second-place heart disease.

Previous surveys with 1997 and 2005 data by the Agency for Healthcare Research and Quality had heart disease at the top, but these lists didn’t include the nursing-home-specific expenses, so may not have captured as much of the spending on Alzheimer’s disease.

Trauma edges out cancer to take third place, with $100.2 billion in 2005 spending. While airbags, anti-lock brakes and other safety innovations have made cars safer, costs per trauma case are going up, Roehrig says. He’s not sure why, but it is likely due to soaring usage of expensive imaging machines and ever-increasing costs of hospital care.

In Depth: The 10 Most Expensive Diseases

Fuzzy Math
Of course, how you count determines what diseases appear on the list as expensive.

The list of the 10 most expensive diseases comprises estimates calculated by Charles Roehrig, health economist at the Altarum Institute in Ann Arbor, Michigan, based on 2005 data. Previous government surveys included community-dwelling patients using data from the federal Medical Expenditure Panel Survey. Roehrig’s estimate, however, provides a fuller picture by also accounting for costs of treating patients in nursing homes, the military, prisons and mental hospitals.

The costs of treating upper gastrointestinal problems surged to $32.7 billion in 2005 from $10.5 billion in 1996–a 14% annual growth rate. The obesity epidemic and exploding use of heartburn drugs mean more people are being treated. But it does not make the list of most expensive diseases because upper GI problems aren’t considered one disease according to the government methodology.

Meanwhile, diabetes wracks up only $35.8 billion in annual expenses. Its main complication is heart disease, whose costs are counted separately.

The truly unfortunate part, however, is that Roehrig says he doesn’t know whether current versions of health care reform will slow surging health costs or not.

The legislation “is bewildering,” he says. “It is impossible to know if the elements in health reform that are designed to save money are going to be successful.”

Expenses for some diseases “are growing because prevalence has gone up, and some are growing because the cost per case has come up,” he says. “It is very hard to pinpoint a leverage point.”

10. Diabetes

$35.8 billion

Annual spending growth rate: 8%

Nearly 24 million Americans have diabetes–and that number is growing thanks to the obesity epidemic. One reason why costs aren’t higher is because the primary way that diabetes kills is by causing heart disease, whose costs are tabulated separately.

9. Kidney Disease

$35.9 billion

Annual spending growth rate: 13%

The invention of kidney dialysis transformed the treatment of kidney failure. It was one of the first super-expensive medical technologies used at the end of life. Another costly treatment for kidney disease is Amgen’s EPO, which treats symptoms of anemia that dialysis patients can experience.

8. Back Problems

$40.1 billion

Annual spending growth rate: 9%

Spending on spine care is surging across the board. One reason is that back surgery is getting more complicated and expensive. Another is that designer narcotic drugs have become much more popular for treating back pain. But one Journal of the American Medical Association study found that all the expense wasn’t helping people feel better.

7. Osteoarthritis

$48 billion

Annual spending growth rate: 8%

Bulging waistlines may be one reason why arthritis costs are growing, as obesity is a risk factor for arthritis. Expensive drugs like Vioxx and Celebrex also added to arthritis treatment costs in the early 2000s. Vioxx was pulled from the market in 2004 after being linked to an increased risk of heart attacks. Celebrex is still sold by Pfizer, but is not as popular as it once was.

6. Hypertension

$50.2 billion

Annual spending growth rate: 9%

Spending on high blood pressure may be going up at an above-average rate because doctors are treating patients more aggressively with multiple drugs. During the time period there were many expensive brand-name blood-pressure drugs that were popular such as Norvasc. Cost growth may slow down in the future if doctors switch to cheaper generic drugs.

5. Pulmonary Diseases

$64.6 billion

Annual spending growth rate: 6%

This category of lung diseases includes asthma and chronic obstructive pulmonary disease, which includes emphysema. COPD costs are growing slowly because of the decline in smoking rates and the fact there are relatively few good treatments.

4. Cancer

$99.4 billion

Annual spending growth rate: 7%

Overall cancer-treatment costs increased in-line with overall medical costs from 1996 to 2005. But costs of treating colon cancer, breast cancer, and prostate cancer rose at double-digit rates thanks to targeted drugs and radiation treatments. Fewer smokers and few effective drugs meant costs for treating lung cancer only rose 2% annually.

3. Trauma

$100.2 billion

Annual spending growth rate: 6%

Even though cars are safer, trauma costs are still rising because it costs more to treat each case. Computed tomography scans and other diagnostic tests cost a lot of money to perform.

2. Heart Disease

$123.1 billion

Annual spending growth rate: 5%

Heart disease is still the nation’s No. 1 killer. But expenses for treating this disease are growing at a below-average rate. One reason may be that fewer people are smoking (the current rate is slightly under 21% vs. 25% in the mid-1990s). Smoking is a big risk factor for heart attacks. Cholesterol-lowering drugs prevent many heart attacks.

1. Mental Health Disorders

$142.2 billion

Annual spending growth rate: 6%

Mental health disorders include everything from Alzheimer’s Disease and Parkinson’s Disease to depression, anxiety and schizophrenia. For psychiatric disorders, cost increases are driven by expensive new drugs used for treating everything from ADD to PTSD, despite limited evidence of effectiveness. Also, many more people are expected to get Alzheimer’s as the population ages.