Introduction
Methods
HLHP strategy logic model development
Assessing the total cost of Quebec’s HLHP strategy
Assessing direct healthcare expenditures associated with lifestyle-related risk factors
Cost of diseases associated with unhealthy habits in Quebec
Assessing the proportion of the costs attributable to the risk factors
Evaluating the point at which savings in healthcare expenditures outweigh the costs of the HLHP strategy
Discounting
Results
The logic model
Cost of the HLHP strategy
Direct healthcare expenditures associated with lifestyle-related risk factors
Cost of diseases associated with unhealthy habits in Quebec
Code | Cause | Direct costs*, †
| |||
---|---|---|---|---|---|
Drugs | Hospital care | Medical care | All direct costs | ||
W000 | All causes | $6,267,268,479 | $10,801,577,118 | $4,647,884,743 | $21,716,730,340 |
W060 | A. Malignant tumours | ||||
W064 | 4. Colon and rectal cancer | $3,682,912 | $112,028,852 | $16,223,691 | $131,935,455 |
W067 | 7. Tracheal, bronchial and lung cancer | $4,750,870 | $123,715,726 | $23,135,123 | $151,601,720 |
W069 | 9. Breast cancer | $13,768,738 | $42,144,588 | $21,509,603 | $77,422,929 |
W079 | C. Type 2 diabetes | $147,840,004 | $132,547,663 | $99,296,278 | $379,683,944 |
W104 | G. Cardiovascular diseases | ||||
W106 | 2. Hypertensive disease | $741,822,143 | $57,843,016 | $169,159,096 | $968,824,255 |
W107 | 3. Ischemic heart disease | $290,308,382 | $505,568,277 | $167,814,583 | $963,691,242 |
W108 | 4. Cerebrovascular disease | $22,588,070 | $396,509,597 | $38,292,634 | $457,390,301 |
W111 | H. Respiratory conditions | ||||
W112 | 1. Chronic obstructive pulmonary disease | $83,672,505 | $229,684,077 | $81,379,783 | $394,736,365 |
W113 | 2. Asthma | $206,389,146 | $69,830,400 | $59,673,740 | $335,893,285 |
W125 | L. Musculoskeletal diseases | ||||
W127 | 2. Osteoarthritis (arthrosis) | $57,525,894 | $138,020,356 | $43,047,497 | $238,593,747 |
Assessing the proportion of the costs attributable to the risk factors
Chronic diseases | Risk factors (RF) | Men | Women | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
RRa
| (95 % CIb) |
P
c (%) | Adj. PAFd (%) | RRa
| (95 % CIb) |
P
c (%) | Adj. PAFd (%) | ||||
(1) Pulmonary diseases | |||||||||||
Chronic obstructive pulmonary disease | Smoker | 4.11 | 3.28 | 5.15 | 18.9 | 59.9 | 3.28 | 2.35 | 4.58 | 15.7 | 39.4 |
Occasional smoker | 2.14 | 1.87 | 2.46 | 6.3 | 2.14 | 1.87 | 2.46 | 4.9 | |||
Former smoker | 2.97 | 2.63 | 3.34 | 42.3 | 1.61 | 1.46 | 1.77 | 38.8 | |||
Insufficient consumption of fruits and vegetables | 1.32 | 1.09 | 1.67 | 56.7 | 15.2 | 1.32 | 1.09 | 1.67 | 39.7 | 11.1 | |
Asthma | Smoker | 1.70 | 1.30 | 2.20 | 18.9 | 13.6 | 1.30 | 0.80 | 2.30 | 15.7 | 6.3 |
Occasional smoker | 1.40 | 1.20 | 1.60 | 6.3 | 1.40 | 1.20 | 1.60 | 4.9 | |||
Obesity | 1.43 | 1.14 | 1.79 | 17.5 | 13.6 | 1.78 | 1.36 | 2.32 | 15.4 | 15.8 | |
Overweight | 1.20 | 1.08 | 1.33 | 41.0 | 1.25 | 1.05 | 1.49 | 27.1 | |||
(2) Cancers | |||||||||||
Lung cancer | Smoker | 8.96 | 6.63 | 12.1 | 18.9 | 73.0 | 7.58 | 5.36 | 10.7 | 15.7 | 68.1 |
Former smoker | 3.85 | 2.77 | 5.34 | 42.3 | 3.85 | 2.77 | 5.34 | 38.8 | |||
Insufficient consumption of fruits and vegetables | 1.21 | 1.04 | 1.45 | 56.7 | 10.6 | 1.21 | 1.04 | 1.45 | 39.7 | 7.7 | |
Breast cancer | Physical inactivity | 1.49 | 1.00 | 2.27 | 63.5 | 23.7 | |||||
Insufficient consumption of fruits and vegetables | 1.12 | 1.01 | 1.25 | 39.7 | 4.5 | ||||||
Post-menopausal breast cancer | Obesity | 1.15 | 1.08 | 1.23 | 15.4 | 4.3 | |||||
Overweight | 1.08 | 1.03 | 1.23 | 27.1 | |||||||
Colon and rectum cancer | Obesity | 1.95 | 1.59 | 2.39 | 17.5 | 27.3 | 1.66 | 1.52 | 1.81 | 15.4 | 18.3 |
Overweight | 1.51 | 1.37 | 1.67 | 41.0 | 1.45 | 1.30 | 1.62 | 27.1 | |||
Physical inactivity | 1.26 | 1.10 | 1.47 | 58.2 | 13.1 | 1.40 | 1.13 | 1.74 | 63.5 | 20.3 | |
(3) Cardiovascular diseases | |||||||||||
Stroke | Obesity | 1.26 | 1.07 | 1.48 | 17.5 | 6.2 | 1.26 | 1.07 | 1.48 | 15.4 | 5.1 |
Overweight | 1.05 | 0.93 | 1.17 | 41.0 | 1.05 | 0.93 | 1.17 | 27.1 | |||
Insufficient consumption of fruits and vegetables | 1.20 | 1.12 | 1.30 | 56.7 | 10.4 | 1.05 | 0.96 | 1.14 | 39.7 | 2.0 | |
Physical inactivity | 1.25 | 1.15 | 1.35 | 58.2 | 12.7 | 1.22 | 1.14 | 1.32 | 63.5 | 12.3 | |
Smoker | 1.43 | 1.35 | 1.52 | 25.2 | 15.3 | 1.72 | 1.59 | 1.86 | 20.6 | 17.6 | |
Former smoker | 1.17 | 1.05 | 1.88 | 42.3 | 1.17 | 1.05 | 1.88 | 38.8 | |||
Ischemic heart diseases | Obesity | 1.72 | 1.51 | 2.24 | 17.5 | 19.7 | 3.10 | 2.81 | 3.43 | 15.4 | 35.1 |
Overweight | 1.29 | 1.18 | 1.41 | 41.0 | 1.80 | 1.64 | 1.98 | 27.1 | |||
Insufficient consumption of fruits and vegetables | 1.11 | 1.02 | 1.22 | 56.7 | 5.9 | 1.32 | 0.95 | 1.82 | 39.7 | 11.1 | |
Physical inactivity | 1.10 | 0.96 | 1.30 | 58.2 | 5.5 | 1.25 | 1.09 | 1.45 | 63.5 | 13.7 | |
Smoker | 1.60 | 1.26 | 2.02 | 25.2 | 12.8 | 3.22 | 2.47 | 4.22 | 20.6 | 34.0 | |
Former smoker | 0.99 | 0.69 | 1.42 | 42.3 | 1.15 | 0.92 | 1.44 | 38.8 | |||
Hypertension | Obesity | 1.84 | 1.51 | 2.24 | 17.5 | 20.7 | 2.42 | 1.59 | 3.67 | 15.4 | 28.3 |
Overweight | 1.28 | 1.10 | 1.50 | 41.0 | 1.65 | 1.24 | 2.19 | 27.1 | |||
Physical inactivity | 1.47 | 1.11 | 2.70 | 58.2 | 21.5 | 1.47 | 1.11 | 2.70 | 63.5 | 23.0 | |
Smoker | 1.15 | 1.03 | 1.27 | 25.2 | 6.7 | 1.15 | 1.03 | 1.27 | 20.6 | 5.8 | |
Former smoker | 1.08 | 1.01 | 1.15 | 42.3 | 1.08 | 1.01 | 1.15 | 38.8 | |||
(4) Metabolic diseases | |||||||||||
Type II diabetes | Obesity | 6.48 | 5.17 | 8.13 | 17.5 | 61.9 | 8.38 | 5.46 | 12.85 | 15.4 | 65.1 |
Overweight | 2.63 | 2.09 | 3.32 | 41.0 | 3.69 | 2.52 | 5.40 | 27.1 | |||
Insufficient consumption of fruits and vegetables | 1.20 | 1.11 | 1.32 | 58.2 | 10.4 | 1.20 | 1.11 | 1.32 | 63.5 | 11.3 | |
Physical inactivity | 1.04 | 0.85 | 1.27 | 56.7 | 2.2 | 1.04 | 0.85 | 1.27 | 39.7 | 1.6 | |
(5) Musculoskeletal diseases | |||||||||||
Osteoarthritis | Obesity | 4.20 | 2.76 | 6.41 | 17.5 | 56.2 | 1.96 | 1.88 | 2.04 | 15.4 | 26.7 |
Overweight | 2.76 | 2.05 | 3.70 | 41.0 | 1.80 | 1.75 | 1.85 | 27.1 |
Chronic diseases | Direct healthcare costs (CAN $2010) | Risk factors (RF) | Adj. PAFa (%) | Costs attributable to risk factors ($) | Total costs adjusted for multiple exposition ($) |
---|---|---|---|---|---|
(1) Pulmonary diseases | |||||
Chronic Obstructive Pulmonary disease | $394,736,365 | Smoking | 49.52 | $195,464,225 | $221,658,019 |
Insufficient consumption of fruits and vegetables | 13.14 | $51,887,048 | |||
Asthma | $335,893,285 | Smoking | 9.88 | $33,195,061 | $77,751,443 |
Obesity and overweight | 14.72 | $49,442,607 | |||
(2) Cancers | |||||
Lung cancers | $151,601,720 | Smoking | 70.56 | $106,973,175 | $111,056,160 |
Insufficient consumption of fruits and vegetables | 9.15 | $13,869,767 | |||
Breast cancers | $77,422,929 | Physical inactivity | 4.55 | $3,520,702 | $21,058,496 |
Insufficient consumption of fruits and vegetables | 23.73 | $18,373,294 | |||
Post-menopausal breast cancers | $61,164,114 | Obesity and overweight | 4.29 | $2,621,537 | $2,621,537 |
Colon and rectum cancers | $131,935,455 | Obesity and overweight | 22.71 | $29,963,004 | $47,049,393 |
Physical inactivity | 16.76 | $22,106,957 | |||
(3) Cardiovascular diseases | |||||
Stroke | $457,390,301 | Smoking | 16.48 | $75,356,930 | $161,321,080 |
Insufficient consumption of fruits and vegetables | 6.17 | $28,230,351 | |||
Physical inactivity | 12.48 | $57,064,937 | |||
Obesity and overweight | 5.63 | $25,751,457 | |||
Ischemic heart diseases | $963,691,242 | Smoking | 23.55 | $226,961,558 | $522,497,040 |
Insufficient consumption of fruits and vegetables | 8.57 | $82,558,945 | |||
Physical inactivity | 9.67 | $93,144,537 | |||
Obesity and overweight | 27.50 | $264,972,860 | |||
Hypertension | $968,824,255 | Smoking | 6.25 | $60,584,638 | $436,253,706 |
Insufficient consumption of fruits and vegetables | 22.24 | $215,504,459 | |||
Obesity and overweight | 24.59 | $238,211,364 | |||
(4) Metabolic disease | |||||
Type II diabetes | $379,683,944 | Insufficient consumption of fruits and vegetables | 1.89 | $7,161,712 | $258,622,744 |
Physical inactivity | 10.85 | $41,212,151 | |||
Obesity and overweight | 63.55 | $241,271,621 | |||
(5) Musculoskeletal diseases | |||||
Osteoarthritis | $238,593,747 | Obesity and overweight | 41.21 | $98,326,933 | $98,326,933 |
Direct costs of chronic diseases | $4,160,937,358 | Total costs attributable to risk factors | $1,958,216,550 |