Economic Cost and Health Burden of Liver Disease in Australia

Deloitte Access Economics: The Economic Cost and Health Burden of Liver Disease in Australia (Jan 2013)

 

Executive Summary

The Gastroenterological Society of Australia (GESA) and Australian Liver Association (ALA) commissioned Deloitte Access Economics to calculate the prevalence, mortality and economic cost of liver diseases in Australia in 2012. The diseases considered were:

  • hepatitis A, B and C;
  • non-alcoholic fatty liver disease (NAFLD);
  • liver cancer;
  • alcoholic liver disease;
  • cholestatic autoimmune liver disease, comprising primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC);
  • haemochromatosis and
  • paediatric liver disease.

 

Prevalence

There is a paucity of contemporary Australian prevalence and mortality data relating to liver disease. In particular there is very little data correlated by age and gender. Several data sources were considered for this report including published and grey literature (such as government reports) and government websites (Department of Health and Ageing, Australian Institute of Health and Welfare (AIHW), NSW Health and Victorian Department of Health). International sources were also included. Members of the GESA expert reference group were contacted for assistance in retrieving data.

The most prevalent liver disease was found to be NAFLD which affects an estimated 5.5 million Australians, including 40% of all adults aged 50 years and above. PBC was the least common, only affecting around 400 Australians aged 35 years and above. Prevalence rates were also applied to the 2030 population projected by the Australian Bureau of Statistics (ABS, 2008) to estimate the number of Australians with liver disease in the future.

 

Mortality

Population mortality rates for the liver disease sub-types were retrieved from a variety of sources including published papers, grey literature and expert opinion. Hepatitis C was responsible for the highest number of deaths (2,550 estimated for 2012). The mortality of people with Hepatitis A, PBC and haemochromatosis was considered to be on par with that of the general Australian population, so no deaths were attributable to these conditions.

 

Cost impacts of liver diseases

The health costs of treating liver disease in 2012 were estimated as $432 million. This includes costs estimated by the AIHW of $386 million (hospital-admitted patient services, out-of-hospital medical services and prescription pharmaceuticals), the national immunisation program ($34 million) and funding for liver disease-related research ($12 million). Two-thirds of the AIHW health spend is for males. In particular, males aged between 35 and 74 years.

The productivity impacts of liver diseases were estimated as $4.2 billion in 2012. Of this cost, $1.9 billion was due to lost lifetime earnings by individuals who died prematurely due to liver diseases and $2.1 billion due to productivity losses associated with lower employment participation. Absenteeism caused an additional cost of $207 million. Productivity costs were borne largely by individuals, but also by Federal Government (in the form of less taxation revenue) and by employers (in the form of sick leave).

Informal care for people with liver diseases is often undertaken by family members or friends and represents an economic opportunity cost of approximately $259 million in 2012, based on data from the Survey of Disability and Carers (SDAC) conducted by the ABS.

In addition there were program payments received by people with primary liver cancer totalling $2 million, the cost of bringing forward funerals ($34 million) and deadweight efficiency losses associated with transfers (taxation forgone and welfare payments) totalling $527 million.

Burden of disease quantifies the impact that liver disease has on wellbeing, where pain, suffering and premature death are measured in terms of "disability adjusted life years" (DALYs). The burden of disease resulting from liver diseases was estimated as $45.3 billion in 2012. Individuals bore 54%, Federal government 31%, state and territory governments 2% and others in society bore 12% of financial costs. Including burden of disease, individuals bore 95%.

 

Potential interventions to offset the burden of liver disease

"Break even" analyses were conducted to assess the effectiveness of two potential interventions aimed at reducing the cost of liver disease in Australia: first, a GESA-led education program to increase awareness of chronic liver diseases through collaboration with Medicare Locals and GESA/ALA; and second, a nurse-led community-based care model, which is supported and linked to a hospital-based liver centre, for liver diseases. A third cost effectiveness analysis was also performed on a primary liver cancer screening program to be aimed at high risk individuals.

For the first two interventions, costs of existing initiatives are not available so estimates were based on the costs of similar initiatives. The National Perinatal Depression Initiative and a nurse-led model of care for Parkinson disease were used, estimated to cost around $6 million and $7.5 million per annum according to the Western Australian Government Department of Health and Parkinson’s Australia, respectively. The breakeven point at which the costs and benefits equate was for preventing 585 symptomatic cases in the education program, and for the nurse-led community care model the break even point was keeping 732 people with liver disease healthy enough that their productivity was on par with that of the general Australian population.

The primary liver cancer screening program was found to be highly cost effective among patients with cirrhosis and males with hepatitis B. The cost per life year gained was $2,646 in 2012.

 

Recommendations

It is recommended that:

  • a national database for sub-entities of chronic liver disease is established;
  • a pilot project is conducted through collaboration between a Medicare Local and GESA/ALA to establish a model liver clinic that delivers multi-disciplinary care to patients with chronic liver disease – focussing on GP, patient and family education, treatment of the disease and prevention of progression, nutritional support to prevent complications related to over- or under-nutrition, social support, links to drug and alcohol services, and tele-health outreach;
  • a pilot project is conducted through collaboration between GESA, the Gastroenterological Nurses’ College of Australia and the Australasian Hepatology Association to establish a nurse-led community-based model of care run from a hospital based liver centre and
  • a trial screening program – a six-monthly alpha fetoprotein blood test and ultrasound – is introduced for the approximately 70,000 Australians who have liver cirrhosis or who are 40+ males with non-cirrhotic hepatitis B.

 

Deloitte Access Economics: The Economic Cost and Health Burden of Liver Disease in Australia (Jan 2013)