Health Care Spending Effectiveness: Estimates Suggest That Spending Improved US Health From 1996 To 2016

“US data from the period 1996–2016 are now available on health care spending by cause from the Disease Expenditure Project (DEX) and on DALYs [disability-adjusted life-years] by cause from the Global Burden of Disease (GBD) Study 2017. DALYs are the sum of years of life lost due to premature mortality, as well as years lived with disability among people living with a given cause. Intuitively, DALYs are a measure of burden, and therefore the goal of health systems is to avert DALYs. A decrease in DALYs is a measure of health gain referred to as DALYs averted. [..]

We estimated all-cause spending effectiveness for 139 causes with spending estimates in the US. We also estimated cause-specific estimates and focus our reporting on the twenty-five causes with the highest total spending and the twenty-five causes with the highest total DALYs in 2016. These two sets overlap, and their union yields thirty-four high-spending or high-burden causes, which account for 73 percent of total spending and 76 percent of total DALYs reported in the two databases. The larger number of cases underlying spending and DALY estimates for these thirty-four causes reduced the uncertainty intervals of those estimates. Burden was predominantly fatal for eighteen of these thirty-four causes for which the ratio of years of life lost to DALYs was greater than 0.5 [e.g., ischemic heart disease; drug use disorders; chronic obstructive lung disease; diabetes mellitus; tracheal, bronchus and lung cancer]. Seven causes were nonfatal (that is, the ratio of years of life lost to DALYs was zero) [e.g., low back and neck pain, depressive disorders, migraines], and four were residual categories indicated by the word “other” at the beginning of the cause name, such as “Other chronic respiratory diseases.”

The researchers estimated DALY contributions from health care separate from contributions due to population size, age-sex structure and exposure to health risks.

Breast cancer was the only condition among the 34 high-spending or high-burden causes where spending decreased AND the DALYs averted increased.

Here is the list of high-spending or high-burden causes where spending increased and DALYs averted decreased (ranked by highest number of DALYs):

  1. Drug use disorders
  2. Alzheimer’s disease and other dementias
  3. Chronic kidney disease
  4. Endocrine, metabolic, blood and immune disorders (not including diabetes mellitus)
  5. Skin and subcutaneous diseases
  6. Alcohol use disorders
  7. Depressive disorders
  8. Other chronic respiratory disease (not including chronic obstructive pulmonary disease)
  9. Other neurological disorders
  10. Gynecological diseases
  11. Migraine

And the top high-spending or high-burden cases where spending increased and DALYs averted increased (ranked by fewest $/DALY averted):

  1. Self-harm
  2. Stroke
  3. Ischemic heart disease
  4. Tracheal, bronchus and lung cancer
  5. Chronic obstructive pulmonary disease
  6. Colon and rectum cancer
  7. Lower respiratory infections
  8. Interpersonal violence
  9. Diabetes mellitus
  10. Congenital birth defects

Full article, MR Weaver, J Joffe, M Ciarametaro, et al. Health Affairs, 2022.7.5