Cost of Non-Communicable Diseases in the EU

Health Promotion Knowledge Gateway

The cost of one disease, generally known as cost-of-illness, estimates the economic burden of a defined disease or health condition in a defined population (Hessel 2008).

The cost of illness is generally estimated by costs associated with the delivery of healthcare (direct costs) as well as indirect costs. The latter, in particular, reflect productivity losses due to morbidity or mortality, early retirement and costs of informal care (Hessel 2008).
More precisely, the estimate of the cost-of-illness depends on the perspective implemented. Usually, from the perspective of both ministry of health and healthcare systems, only direct costs are included in the estimated costs. If, instead, a societal perspective is preferred, both the direct and the indirect costs will be included (Kirch 2008).

Measuring the cost of non-communicable diseases

The economic burden of non-communicable diseases (NCDs) is rising and expected to show steeper increases in the future, especially in less developed economies and among the poorest in both middle- and high-income countries. Life expectancy is increasing in EU member states due to a fall in mortality rates at all ages. However, longer lives sometimes translate into increased morbidity, meaning more years spent with chronic illnesses (EC 2021).

The high socioeconomic cost of NCDs has a significant impact on individuals and households, health systems and economies, as detailed below (HNP 2011):

Individual and household level: increased disabilities and premature deaths, decreased household income, increased expenditures (including out of pocket and catastrophic payments for health), loss in savings;
Healthcare costs: more people living with NCDs leading to increased use of NCD-related healthcare services, high medical treatment costs and high demand for more expensive treatments;
Societal costs: indirect costs as reduced labour outputs, lower tax revenues, lower returns on human capital investments.

Healthcare expenditure is among the largest and fastest growing spending items for governments and individuals. On average^a, healthcare expenditure was 8.3% of GDP in 2019 and 9.1% in 2020 in the EU countries. In two thirds of Member States the public sector finances more than 70% of total expenditure on health (OECD Data Explorer).

Due to population aging, chronic diseases and the diffusion of new diagnostic and therapeutic technologies, the share of GDP spending on health is predicted to increase in the coming years (EC 2021, OECD/EU 2022). In OECD countries, NCDs are responsible for the biggest share of such healthcare costs (OECD 2016).

Furthermore, premature deaths due to major NCDs (cardiovascular diseases, cancers, respiratory diseases and diabetes) cost EU economies 0.8% of GDP (OECD/EU 2016), with further losses incurred due to the lower productivity and employment rates of people living with chronic health problems.

Healthcare costs

Cost-of-illness studies have estimated the cost to EU health care systems from cardiovascular disease (CVD) and cancer. The estimates include costs due to primary care, outpatient care, accident and emergency, inpatient care and medications/drugs. The healthcare costs for CVD and cancer were estimated as follows:

CVD direct costs to EU health care systems^b were almost €111 billion in 2015, approximately €18 billiondue to ischaemic heart disease (IHD) and more than €20 billion due to stroke (EHN 2017);
Direct cancer costs to the EU were almost €97 billion in 2018 (Hofmarcher et al. 2020).

The estimated country-based healthcare costs caused by CVDs (total, ischaemic heart disease and stroke) and cancer are listed in Table 1.

Table 1: Estimated healthcare costs of CVD and cancer

Estimates of healthcare expenditure due to diabetes in the adult population (aged 20-79 years) were performed also for the European Region (IDF 2022). The International Diabetes Federation European Region (IDF Europe countries) estimated that in 2021 this expenditure was €167.5 billion.

Indirect costs

Non-communicable diseases also result in indirect costs, for example productivity losses due to morbidity or mortality, early retirement and costs of informal care. Studies have estimated these costs as follows:

production losses due to mortality and morbidity associated with CVD^b cost €54 billion in the EU in 2015 and the total cost of providing informal care for people with CVD was almost €45 billion(EHN 2017);
cancer cost over €66 billion in productivity losses due to mortality and morbidity in the EU in 2018 and over € 25 billion in informal/family care spending (Hofmarcher et al. 2020).

The country-based indirect costs are reported in Table 2.

Table 2: Estimated non-healthcare costs of CVD and cancer