INDIRECT COSTS OF DISEASE - AN INTERNATIONAL COMPARISON

Results of economic evaluations are often strongly influenced by estim ates of indirect costs. International comparability of these estimates may contribute to rational decision-making in health care policy. Hen ce, estimates should be international comparable. Comparability of the se results between countries may be hampered due to variation in metho dology, data sources, valuation of production losses, and social secur ity arrangements. Furthermore differences in epidemiology, demography and economic environment may cause variation in the level and the dist ribution by diagnosis of indirect costs. In this study indirect costs of disease for the Netherlands are compared with estimates for Sweden and the United States. We found large differences: both in the share o f indirect costs in GDP as in the constituting elements, absence from work, disability and mortality. The level of indirect costs due to abs ence from work and the distribution according to diagnosis are quite s imilar for the two European countries. The costs of disability are par ticularly high for the Netherlands. Comparison of disability costs bet ween the three countries is hampered due to lack of quantitative infor mation on the influence of social insurance arrangements on the level of indirect costs and the distribution by diagnosis. The large number of deaths at young age in the U.S. is responsible for the higher morta lity costs compared to the two European countries.