Most Costly Conditions

In somewhat of a companion to our post yesterday about total national health spending, the Agency for Healthcare Research and Quality released a Statistical Brief examining the ten most costly conditions for adult men and women in 2008, based on Medical Panel Expenditure Survey data.  Overall men and women have the same top ten conditions but in a slightly different order.  Both have heart disease and cancer as the two most expensive conditions.  After that for women it is mental disorders, trauma, osteoarthritis, asthma, hypertension, diabetes, back problems and hyperlipidemia.  For men after the top two, it was trauma, osteoarthritis, mental disorders, diabetes, hypertension, hyperlipidemia, asthma and back problems.  The differences in order may be partly attributed to women having a longer average life expectancy–dementia is more likely as we age– and gender differences in disease, for example osteoporosis leads to back problems and is more prevalent in women.  (AHRQ Brief)

In terms of actual cost, heart disease was $44 billion for women and $47 for men and cancer was $38 billion for women and $34 billion for men.  The lowest cost of the ten for women was hyperlipidemia at $18 billion and for men it was back problems at $14.4 billion.  Looking at prevalence as opposed to cost, hypertension was number one, with 29.5 million women and 25.6 million men.  Prevalence was relatively even for most of the conditions but women had almost twice as many mental disorders, again likely the result of living longer, and much higher osteoarthritis rates.  Hyperlipidemia also had a very high number of both men and women with the diagnosis.

The average expenditure per person with the condition was highest for cancer, at $4873 for men and $4484 for women.  The average for heart disease was $3723 for women and $4363 for men.  Hypertension and hyperlipidemia had the lowest average costs, a blessing considering their prevalence and also reflecting the efficacy of drug therapy in avoiding serious acute episodes.  Medicare paid for over half of heart disease expense for women and about 38% for men.  Medicaid paid for relatively little of the costs for the conditions, likely reflecting the younger age of that population.  Private insurers picked up the biggest piece of cancer costs both for men, at 46%, and women, at 31%.  Between the general spending analysis and the condition specific one, we know that a few people with a few conditions account for most spending, but somehow we still haven’t figured out a good, widespread way to manage those costs better.