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Session: Health Economics in the Baltics
Room: Chydenius Rooms
Time: Sat 10:15-11:30

Presenter: Marge Reinap (Tallinn University of Technology. Tallinn School of Economics and Business Administration)

Abstract

Objective. To estimate the economic costs of five behavioral risk factors in Estonia in 2006 using prevalence-based cost-of-illness methodology.
Methods. The economic costs of alcohol use, smoking, physical inactivity, obesity and inadequate vegetable and fruit intake were estimated using risk factor attributable deaths and prevalence of diseases along with economic costs associated with these diseases. The population attributable fractions of risk factor related diseases were calculated by combining the country-specific prevalence of risk factors by age and sex with literature based relative risks. The economic costs consist of direct and indirect costs. Direct costs are the value of resources used to diagnose; treat and rehabilitate risk related diseases and were extracted from Estonian Health Insurance Fund databases that cover hospital care, other institutional care and ambulatory services. Double counting of health expenditures was avoided by using the primary diagnoses only. Indirect costs that are productivity losses due to morbidity and premature mortality were calculated according to human-capital approach with 3% discount rate (0% and 10% rates were additionally used in sensitivity analysis). Data on disease duration and impact on productivity was obtained from Estonian national Burden of Disease study. The calculations of lifetime earnings used National Registry of Pension Insurance data that are based on national pre-tax wages including the social security tax and unemployment insurance tax for age-gender stratified population data.
Results. Overall, alcohol use is overwhelmingly the most costly lifestyle risk factor in Estonia with 2002 million Estonian kroons (MEEK) (€128 million). The costs related to alcohol use represent 1% of gross domestic product (GDP). Alcohol use is followed by smoking (1025 MEEK – €66 million), overweight (859 MEEK – €55 million), physical inactivity (783 MEEK – €50 million) and inadequate vegetable and fruit intake (350 MEEK – €22 million). The productivity losses due to morbidity cause the largest economic burden for most health risks (excluding physical activity), comprising 57%-66% of the total cost of each health risk. Alcohol use has the biggest negative impact on productivity. It is the leading risk factor for both morbidity and mortality induced productivity losses, 1250 MEEK (€80 million) and 401 MEEK (€26 million), respectively. The latter comprises 34% of the total premature mortality related productivity loss in Estonia. Physical inactivity is the most health resources consuming risk factor – 387 MEEK (€25 million) was spent to alleviate its health consequences.
Conclusion. Unhealthy lifestyle places significant economic burden on Estonian society and the findings indicate the significant amount of potential savings that are possible to gain trough improvement of health behavior in Estonia. The foremost health risks for targeting scaled-up prevention efforts and additional resources are alcohol use, smoking and physical inactivity. This is especially important because concurrent investments into prevention of addressed health risks were minor compared to the economic costs to society.

Key Terms

economic costs, cost-of-illness, health risks, lifestyle risk factors

Authors:

Marge Reinap (Tallinn University of Technology. Tallinn School of Economics and Business Administration)

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