Role

of NCDs as a Healthcare Cost Driver

Candace DeMatteis, Policy Director October 9, 2011

Why shi5 the focus of healthcare delivery?

Healthcare cost growth is like a sink thats overflowing . . . were so focused on mopping up the water, no one is reaching up to turn off the faucet.

Global Growth in Non Communicable Diseases

Cause 60% of all deaths globally; Over the next 10 years, deaths from NCDs expected to increase 17%. This year , 36 M people will die from an NCD. Globally, 350M diabeJcs by 2030. 2.3B adults are overweight. 700M adults are obese.
The WHO list of the most common non communicable diseases:
Asthma Cancer Cardiovascular diseases Chronic Obstructive Pulmonary Disease Congenital conditions Diabetes Diseases of the digestive system Eye conditions Genitourinary conditions (prostate disorders, nephritis) Neuro-psychiatric conditions Skin conditions and musculoskeletal conditions (arthritis) Skin Diseases

3 Source: WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases (2008)

Economic Impact of NCDs

Lost national income from premature deaths due to heart disease, stroke and diabetes

Lost National Income ($billions) Countries 2005 2005-2015 (cumulative)

Brazil China India Russian Federation

WHO Chronic Disease Report 2005

3 18 9 11

49 558 237 303

The real driver of cost is non communicable disease

Major Risk Factors for NCDs

High Cholesterol Level Overweight & Obesity Physical Inactivity

Leading Risk Factors as % of Total Deaths in 2004: Worldwide & MiddleIncome Countries

High blood glucose level Tobacco Use

WHO esJmates that 80% of heart disease, stroke, and type 2 diabetes, 90% of COPD, and 40% of cancer could be prevented if people would Eat healthy diets Increase physical acJvity Stop smoking

High blood pressure

Source: WHO Global Infobase, https://apps.who.int/infobase, Accessed July 20, 2010; K.M. Venkat Naran et al. Global Noncommunicable Diseases New England Journal of Medicine, September 2010

The Economic Challenge

Healthcare Spending growth can be decomposed into:
Change in treated prevalence Change in spending per treated case InteracJons

About 2/3 growth linked to treated prevalence increases .

The Opportunity
U.S. spends very little on prevention, despite behavioral and environmental factors accounting for 70 percent of U.S. deaths

Causes of Avoidable Mortality

U.S. Investment in Prevention

30% - Other Contributors (genetics, health care, etc.) 70% Behavioral and Environment al Factors

1% - 3%- PrevenJon 97 % Medical Care Research

Source: Institute of Medicine, Health Affairs, Journal of American Medical Association (JAMA)

Prevalence of Selected Chronic Disease Risk Factors, India 2008

Chronic Disease Risk Factor
High Blood Pressure Overweight or Obese High Cholesterol Raised Blood Glucose Daily Smoking

Age Standardized Prevalence

35.2 11.2 27.9 10.9 14.8

Cardiovascular Disease in India: Projected Number of PaQents

Source: NCMH Background Papers: Burden of Disease in India

Diabetes in India: Projected Number of Cases (in Millions)

The Partnership to Fight Chronic Disease Is Driving Policymakers to Recognize Preventable Chronic Disease and its Role in Rising Healthcare Costs
A non partisan NGO consisting of healthcare experts and stakeholders dedicated to fighting the #1 driver of rising health costs: preventable chronic disease.

Educate Key Policy Leaders

Drive the Debate Toward Meaningful Solutions to Combat Chronic Disease

Key Activities:

Address Access Concerns/ Partner in Expanding Access

Educate Mobilize Challenge

End Goal: Begin to Refocus the Cost Debate on the True Cost Drivers in Healthcare

PFCD in America

ExecuQve Director: Ken Thorpe, Professor and Chair, Rollins School of Public Health, Emory University, Former Deputy Assistant Secretary for HHS

More than 130 naQonal partner organizaQons, and thousands of partners in 17 states
PaQent and provider groups Public health groups Civic groups Labor unions Major employers and business groups Insurers and other health groups Academic insQtuQons

CreaQng the Value ProposiQon -- Why Focus on NCDs?

Reduce long-term healthcare costs

The rising prevalence of chronic disease is a primary driver of rising healthcare spending by people, their families and payers Many diseases can be prevented, detected and treated to avoid costly complicaQons Chronic disease prevent people from working to their full potenQal When sick people go to work, they are less producQve, make mistakes, and are injured more frequently Family members o5en take o from work to care for the sick Reducing the economic burden of disease promotes sustainable growth Improving health increases the quality of life

Improve producQvity & economic growth

Improve quality of life

Major U.S. Media Outlets Covering NCDs and Risk Factors as Key Cost Driver

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Key Findings

Prevention is the most salient and important solution to the problem.

Vaccines are an important element of prevention Local-based efforts deemed most effective. Need for greater coordination between players. Partnerships provide credibility and are deemed more effective strategies. Promoting adherence an important element of intervention. Patient-centered, community-based programs that empower patients differentiates intervention from traditional disease management. The most successful intervention strategies include partnerships with employers and provide incentives to patients/employees.

Intervention definition easily embraced.

New treatments and technology are important but stakeholders want more than therapeutic innovation

Vaccines (i.e. cervical cancer) are a home run allowing respondents to connect the dots. Need for innovation to improve access; care ccordination and self-management support.

The GlobalizaQon of NCDs

Cancer, diabetes, heart diseases are no longer the diseases of the wealthy. Today, they hamper the people and the economies of the poorest populaQons, even more than infecQous diseases. This represents a public health emergency in slow moQon.
-Ban Ki-Moon, United NaJons Secretary-General

The World Economic Forum 2009 Global Risks Landscape Assessment Report idenQed chronic diseases as one of the most signicant risks facing the global economies.
www.weforum.org/pdf/globalrisk/globalrisks09/global_risks_2009.pdf

www.fightchronicdisease.org

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