Incorporating economic modeling and cost estimation into local public health data

Background: Public Health Services embarked on a major, multi-year health promotion effort to reduce death and disability due to chronic disease in the County. While incidence and prevalence data on chronic diseases and relevant behavioral data were readily available, there was no local level data on the economic cost of chronic disease. This data was necessary in order to create cost benefit analyses and return on investment models to support the need for prevention and early intervention.

Methods: Epidemiologists identified existing research on national level cost estimation of chronic disease. Estimated costs were limited to direct medical costs only. Multiple data sources were available but for differing geographies. MEPS provided expenditure data by condition at the Regional level, which was adjusted to the County level. CMS provided point of service data used to verify estimates. Incidence data was available through Public Health Services. Prevalence data was available through the California Health Interview Survey (CHIS). Costs were adjusted for medical inflation.

Results: The results showed that direct medical costs associated with chronic disease in the County totaled $4.6 billion in 2007. Local costs were projected to $25 billion in 2050 based on national projections. Annual total and per person cost for each of seven chronic diseases were also calculated.

Discussion: These methods have now been applied to other health issues including injury and violence. Cost data has become an integral part of population health epidemiology. These models can be used to provide evidence to support the costs of local prevention activities.