The incidence and economic costs of cancer, motor vehicle injuries, coronary heart disease, and stroke: a comparative analysis

Our plain-English summary of The incidence and economic costs of cancer, motor vehicle injuries, coronary heart disease, and stroke: a comparative analysis, by N.S. Hartunian, C.N. Smart, M.S. Thompson (American Journal of Public Health, 1980).

The study

• Authors: N.S. Hartunian, C.N. Smart, M.S. Thompson
• Journal: American Journal of Public Health
• Published: 1980;70(12):1249-60
• Read it: PubMed · Publisher · Free full text

Abstract

The economic impact of disease and injury has most often been calculated by examining the costs associated with the prevalence of the impairments in the reference year. An alternative accounting approach is to assign all disease costs to the year of incidence, an approach which entails present-valuing to the year of incidence both health care expenditures and lost productivity. The incidence approach is the more appropriate for gauging the economic gains achievable through prevention, immediate rehabilitation, and arresting progression. Incidence-based costs have been estimated for the United States in 1975 for cancer, coronary heart disease, motor vehicle injuries, and stroke. A noteworthy finding is the relative economic importance of motor vehicle injuries, which frequently have been overlooked in the ordering of public health expenditure priorities. After cancer, which generated approximately $23.1 billion in present-valued costs in 1975 (discounted at 6 per cent), motor vehicle injuries and coronary heart disease constitute the next most expensive conditions--having generated estimated annual costs of $14.4 billion and $13.7 billion, respectively. Stroke, at $6.5 billion, follows in economic importance.

In plain English

This study estimated the economic costs of cancer, coronary heart disease, motor vehicle injuries and stroke in the United States in 1975. It used an "incidence" approach, assigning all future treatment costs and lost earnings to the year a condition first appears, discounted at 6 per cent. Cancer had the highest estimated total cost, about $23.15 billion. Motor vehicle injuries followed at $14,435 million, then coronary heart disease at $13,716 million and stroke at $6,456 million. For all four conditions, lost earnings (indirect costs) exceeded direct costs. Direct costs included treatment, insurance administration and, for motor vehicle injuries, legal and court costs. Average forgone earnings per affected person were $25,334 for cancer, $17,010 for heart disease, $16,102 for stroke (excluding transient ischemic attacks) and $2,263 for motor vehicle injuries. Cancer accounted for the most life years lost, 6.94 million. The authors concluded that such incidence-based costs should help decisions about preventive programs. They noted that their figures leave out pain, suffering and grief. Analysts' choices, such as the discount rate, could shift results by a factor of two. Litigation charges were separately estimated only for motor vehicle injuries.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Economic cost-of-illness analysis using the incidence approach, with sensitivity analyses
• Who was studied: New cases of the four conditions in the United States in 1975 (U.S. population 213,630,000): 660,680 cancers, 659,926 coronary heart disease cases, 4,270,395 motor vehicle injuries and 252,866 strokes (strokes exclude transient ischemic attacks). Cancers were grouped by body system (digestive, respiratory, reproductive and others).
• Main results:
  • Estimated total incidence-based cost of all cancers in 1975 was $23.15 billion, compared with a prevalence-based estimate of $22.36 billion by another group (Berk)
  • Total costs for motor vehicle injuries: $14,435 million, of which $4,773 million direct and $9,662 million forgone earnings
  • Total costs for coronary heart disease: $13,716 million, of which $2,491 million direct and $11,225 million forgone earnings
  • Total costs for stroke: $6,456 million, of which $2,368 million direct and $4,088 million forgone earnings
  • For all four conditions, indirect costs exceeded direct costs: 4.5 times for heart disease, 2.6 for cancer, 2.0 for motor vehicle injuries, 1.7 for stroke. Direct costs included treatment as well as 'other' costs (insurance administration and, for motor vehicle injuries, legal and court costs).
  • Average forgone earnings per person: $25,334 for cancer, $17,010 for heart disease, $16,102 for stroke (stroke figure excludes transient ischemic attacks), and $2,263 for motor vehicle injuries
  • Total life years lost by people newly affected in 1975 were greatest for cancer (6.94 million), then coronary heart disease (3.43 million), motor vehicle injuries (2.01 million) and stroke (1.68 million)
  • Among people with stroke, males aged 35 to 64 made up 15 per cent of incidence but 52 per cent of all forgone earnings
• The authors' conclusion: The authors concluded that incidence-based cost estimates like theirs should usefully assist decisions about preventive programs, while prevalence-based estimates are most pertinent for programs aimed at people already living with long-term conditions.
• Limitations the authors state:
  • Economic costs do not capture pain and suffering, grief, the value of leisure time, or the symbolic aspects of illness
  • Analysts' discretionary choices (discount rate, productivity growth, valuing household labor) can shift results for a given condition by a factor of two
  • Treatment cost and work incapacity data contributed most to overall imprecision; the authors estimated the overall standard error at 15 per cent or less
  • Litigation charges were separately estimated and included only for motor vehicle injuries, not for the three diseases (for example, worker compensation proceedings for people with cancer). The authors noted that such data are sparse and that many of these costs are already part of health insurance administrative overhead.
  • The current state of the art in estimating economic costs of illness has limited numerical precision

Related studies

• Occupational exposure to particulate air pollution and mortality due to ischaemic heart disease and cerebrovascular disease — K. Torén, I.A. Bergdahl, et al. (2007)
• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Mortality of auto mechanics. A ten-year follow-up — E.S. Hansen (1989)
• Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016 — GBD 2016 Occupational Risk Factors Collaborators (2020)
• Asbestos exposures of mechanics performing clutch service on motor vehicles — H.J. Cohen, D.R. Van Orden (2008)
• Cancer survival and prevalence in Australia: period estimates from 1982 to 2010 — Australian Institute of Health and Welfare (2013)

Browse more research in American Journal of Public Health, or return to medical research.