1. Economic Burden of Illness in Canada (EBIC) 2014 Report by PHAC for 2005 – 2008 CPHA 2014 Conference Presentation Joe Devlin, Senior Health Economist Public Health Agency of Canada

2. The Economic Burden of Illness Canada (EBIC) Report Comprehensive cost-of-illness (COI) and injury study based on standard reporting units and methods Provides stakeholders with objective and comparable information on the magnitude of the economic burden of illness and injury in Canada EBIC reports are available for select years: »Past EBIC estimates published for 1986, 1993 and 1998 »2000 EBIC estimates available, however not published »EBIC 2005 – 2008 targeting a June 2014 release date Economic Burden of Illness in Canada, 2005-2008 2

3. What will EBIC 2005-2008 include? Comparable cost totals including information on: »Diagnostic category, sex, and age group »Direct costs (hospital care, physician care, and drugs) »Indirect costs (value of lost production due to morbidity and premature mortality) Costs estimates attributable to 165 unique diagnostic subcategories based on most responsible diagnosis »No comorbidity or provincial-level cost estimates »Cost estimates by ICD code for special requests EBIC Online Tool: developed to increase accessibility for stakeholders and facilitate future data releases Economic Burden of Illness in Canada, 2005-2008 3

4. EBIC Direct Cost Components Hospital care »2005-2008 estimates attributed to the most responsible health condition for all hospital types (e.g. general, psychiatric, chronic and rehabilitation) »Data sourced from the Canadian Institute for Health Information (CIHI) Physician care »2005-2008 estimates based on publically available Manitoba cost totals rather than P/T record-level physician billing data »Manitoba cost totals available by sex and ICD chapter; estimates for other P/Ts derived by per capita method »To obtain ICD code-level cost estimates, EBIC 2000 cost distributions (by P/T, age group and sex) were used Drugs »2005-2008 estimates based on linked data from retail pharmacies and diagnostic information from a physician survey »Data sourced from IMS Brogan Economic Burden of Illness in Canada, 2005-2008 4

5. EBIC Indirect Cost Components Value of lost production due to morbidity and mortality: »Provincial unemployment duration used to denote the ‘friction period’ (time to replace a sick or deceased worker) »Sex, age group and province-specific earnings used to value lost production Change in methodology for measuring lost production costs »EBIC 2005-2008 uses the friction cost method (FCM) not the human capital method (HCM) used in previous EBIC reports »Based on recommendations by national and international experts who attended the 2009 and 2010 EBIC workshops hosted by PHAC Adopting the FCM leads to lower indirect cost estimates »EBIC 1998 indirect cost estimates were ~47% of total »EBIC 2005-2008 indirect cost estimates were ~10% Economic Burden of Illness in Canada, 2005-2008 5

6. 6 Period of lost production using HCM A= Point individual becomes unable to work due to illness/injury B= Point individual would reach retirement age or life expectancy C= Point where job vacancy is filled (end of the friction period) B Y t-1 YtYt Y t+10 A period of lost production Period of lost production using FCM Y t-1 YtYt Y t+10 A B period of lost production C

7. Cost Estimates by Cost Type and Cost Component, Canada, 2005-2008 ($’000,000 2010 Constant Dollars) Year Direct CostsIndirect Costs Total Costs Hospital Care Drug Physician Care UnattributableSubtotalMortalityMorbidityUnattributableSubtotalAll 200533,83119,29712,25987,836153,2244709,7666,31816,230169,454 200635,93619,99112,99692,147161,0694719,9316,19616,499177,568 200738,22420,95213,05095,204167,43046210,1176,09716,774184,205 200839,74521,63313,766100,479175,62346410,4235,99417,205192,828 Economic Burden of Illness in Canada, 2005-2008 7

8. Cost Distribution by Cost Component for the Five Diagnostic Categories with the Highest Total Costs, Canada, 2008 Economic Burden of Illness in Canada, 2005-2008 8

9. Cost Distribution by Sex and Cost Component, Canada, 2008 Economic Burden of Illness in Canada, 2005-2008 9

10. Cost Distribution by Age Group and Cost Component, Canada, 2008 Economic Burden of Illness in Canada, 2005-2008 10

11. EBIC – Beyond 2008? PHAC is considering several next steps: »Allocate more of the “unattributable” costs »Attribute costs to multiple diagnoses (comorbidities) »Provide provincial-level results (confidentiality constraints) »Estimate the economic burden of informal caregiving »Estimate the time spent seeking medical care »Include intangible costs (e.g. pain and suffering) »Examine the relationship between costs and illness burden »Implement a more regular release cycle Economic Burden of Illness in Canada, 2005-2008 11

12. Questions? Thank you! EBIC Key Contact: Dr. Alan Diener, PhD Manager, Population Health Economics Public Health Agency of Canada 120 Colonnade Road Ottawa, Ontario K1A 0K9 Telephone : 613-952-2368 alan.diener@phac-aspc.gc.ca Economic Burden of Illness in Canada, 2005-2008 12