COI Rankings

V. Key Health Policy Issues >> A. Burden of Illness >>Cost-of-Illness (COI)>>COI Rankings (last updated 8.17.16)

Key Questions

What are the most expensive major diagnostic categories?

Total Costs (direct and indirect)

All the studies shown use a standardized methodology for measuring direct and indirect costs, so comparisons across major diagnostic categories are not as problematic as comparisons across specific conditions.

  • Dorothy P. Rice. 1966. Estimating the Cost of Illness: Health Economics Series No. 6. PHS Pub. No. 947-6 (Washington, D.C.: U.S. Government Printing Office). Direct, morbidity and mortality losses for 1963 are reported for 8 major diagnostic categories: neoplasms; mental, psychoneurotic, and personality disorders; diseases of nervous system and sense organs; diseases of circulatory system; diseases of respiratory system; diseases of digestive system; diseases of bones and organs of movement; injuries; and all other.
  • Dorothy P. Rice. Estimating the Cost of Illness. American Journal of Public Health 57(3) (March 1967): 424-440. The identical MDCs are reported from Rice’s PHS monograph, except that the estimates  do not account for the lifetime mortality losses of decedents in 1963, focusing instead on the mortality losses experienced during calendar year 1963.
  • Dorothy P. Rice and Barbara S. Cooper. The Economic Cost of Illness Revisited. Social Security Bulletin 39(2) (Feb. 1976), 21-36. [Abstract][Full Text]. Direct, morbidity and mortality losses for 1972 are reported for 16 major diagnostic categories.
  • Dorothy Rice, Thomas A. Hodgson and Andrea Kopstein. The Economic Costs of Illness: A Replication and Update. Health Care Financing Review 7, No. 1 (Fall 1985): 61-80. [Abstract] Direct, morbidity and mortality losses for 1980 are reported for 16 major diagnostic categories.

Direct Costs Only

  • Hodgson TA, Kopstein AN. Health care expenditures for major diseases in 1980. Health Care Financing Review 1984;5(4):1-12.
  • T.A. Hodgson and A.J. Cohen. Medical expenditures for major diseases, 1995. Health Care Financing Review 1999;21(2):119-16. [Full Text (pdf)]

What are the most expensive illnesses in the U.S.?

In a report to Congress (2000), the NIH director noted the following important limitations of comparing COI estimates across illnesses:

  • “Variability in methods and data. There is considerable variability in the methods and data used to generate COI estimates. As a result, cost estimates for different diseases, or even for the same disease, may not be comparable. For example, one analysis may include only treatment costs, while another may include estimates of the value of lost production due to morbidity and mortality. Many patients have more than one disease/condition simultaneously, such as heart disease and diabetes, or have other underlying risk factors such as smoking and alcohol abuse. In such cases, costs may be allocated on the basis of primary diagnosis only, or some share may be attributed to comorbidities or underlying, contributory conditions. Furthermore, there is an inherent imprecision in estimating accurately items such as the costs of physician visits, hospital stays, and the value of lost productivity due to death and disabilities.
  • Burden of illness exceeds economic costs. Estimates of the economic costs of illness do not capture some important aspects of the burden of illness such as reduced functioning, pain and suffering, and deterioration in other dimensions of health-related quality of life including emotional and psychological impacts on families, friends, and co-workers.”

“However, COI estimates can provide order of magnitude indicators of the economic burden of particular diseases.”  With these caveats in mind, the following provide rough estimates of the relative COI across selected conditions:

  • Conover CJ. Annual Cost of Illness and Injury: Most Costly Health Conditions in U.S. (billions of dollars, Year 2000). coitop25.xls. This unpublished table from Duke University Center for Health Policy is somewhat dated, but provides a league table of the “top 25” most costly conditions, based on the full estimated COI for each listed disease, inclusive of direct, indirect and intangible costs, with details on morbidity and mortality losses when these are reported.
  • Cohen JW and Krauss KA. Spending and Service Use Among People With the Fifteen Most Costly Medical Conditions, 1997. Health Affairs 2003, 22 (2): 129-138. (Abstract). These figures are based on the 1997 Medical Expenditure Panel Survey and therefore have the advantage of using a standardized methodology across all diseases, which permits reporting of median and mean cost per individual having a particular disease, along with breakdowns of spending by major type of service. Unlike the Rice et al. studies, this one focuses exclusively on direct costs, does not account for all U.S. health expenditures, but merely reports findings for the most expensive illnesses.
  • Research Triangle Institute. Cost-of-Illness Summaries for Selected Conditions. (January 2006). (pdf). This is a tabular compilation of COI estimates for a large number of diseases, based on the studies reviewed in the report below, updated to 2004 dollars, with a breakdown of direct, indirect and intangible losses, along with other selected details about characteristics of each study.  No ranking is provided, and in some cases, multiple COI estimates are reported for the same disease. But in theory, after reconciling multiple estimates, one could construct a 2004 ranking from these results.
  • Research Triangle Institute. Reviews of Current Cost-of-Illness Studies. (January 2006). (pdf). This is a 300+ page compilation of abstracted COI studies using a common template for reporting on methods and sources. The compilation is intended to update the NIH 2000 report report, so it excludes all studies from that report except in instances where no more recent study could be found for a particular disease.
  • NIH. Disease-Specific Estimates of Direct and Indirect Costs of Illness and NIH Support, Fiscal Year 2000 Update. Department of Health and Human Services. National Institutes of Health. Office of the Director. The full report provides complete details regarding methods, with COI estimates and NIH spending for the 14 of the 15 leading causes of death in 1998, and for 46 other diseases and conditions. This tabulation reports direct and indirect costs and the reference year of the cost estimates, but does not update these to a common reference year.  The table includes the discount rate used for mortality losses and cites other methodological details.  But no ranking is provided; in theory, one could construct a ranking from these results only after updating each cost component to a common reference year.

3 Responses to COI Rankings

  1. Michael Dennis says:

    Trying to track down a copy of the last one “NIH. Disease-Specific Estimates of Direct and Indirect Costs of Illness and NIH Support, Fiscal Year 2000 Update.” but your links are not working. Can you by chance send a copy?

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