Journal of Preventive Medicine and Public Health

Special Article

Measuring Trends in the Socioeconomic Burden of Disease in Korea, 2007-2015: Tae Eung Kim, Ru-Gyeom Lee, So-Youn Park, In-Hwan Oh; J Prev Med Public Health. 2022;55(1):19-27. Published online January 31, 2022; DOI: https://doi.org/10.3961/jpmph.21.594

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Abstract Summary PDF Supplementary Material

This study estimated the direct and indirect socioeconomic costs of 238 diseases and 22 injuries from a social perspective in Korea from 2007 to 2015. The socioeconomic cost of each disease group was calculated based on the Korean Standard Disease Classification System. Direct costs were estimated using health insurance claims data provided by the National Health Insurance Service. The numbers of outpatients and inpatients with the main diagnostic codes for each disease were selected as a proxy indicator for estimating patients’ medical use behavior by disease. The economic burden of disease from 2007 to 2015 showed an approximately 20% increase in total costs. From 2007 to 2015, communicable diseases (including infectious, maternal, pediatric, and nutritional diseases) accounted for 8.9-12.2% of the socioeconomic burden, while non-infectious diseases accounted for 65.7-70.7% and injuries accounted for 19.1-22.8%. The top 5 diseases in terms of the socioeconomic burden were self-harm (which took the top spot for 8 years), followed by cirrhosis of the liver, liver cancer, ischemic heart disease, and upper respiratory infections in 2007. Since 2010, the economic burden of conditions such as low back pain, falls, and acute bronchitis has been included in this ranking. This study expanded the scope of calculating the burden of disease at the national level by calculating the burden of disease in Koreans by gender and disease. These findings can be used as indicators of health equality and as useful data for establishing community-centered (or customized) health promotion policies, projects, and national health policy goals.

Summary

Korean summary
2007년에서 2015년 기간의 건강보험 자료 등을 이용하여, 해당기간의 경제적 질병부담을 측정하였으며, 해당 기간동안 경제적 질병부담은 20%의 증가를 나타내었다. 동 기간동안 비감염성 질환의 경제적 질병부담의 비율은 약 70%로 나타났으며, 감염성 질환은 약 10%, 손상은 20%로 나타났다. 한편 개별 질병군 기준으로는 자살을 포함한 자해가 1위를 차지한 해가 가장 많았다.

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Original Article

Estimating Influenza-associated Mortality in Korea: The 2009-2016 Seasons: Kwan Hong, Sangho Sohn, Byung Chul Chun; J Prev Med Public Health. 2019;52(5):308-315. Published online August 23, 2019; DOI: https://doi.org/10.3961/jpmph.19.156

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Abstract Summary PDF

Objectives
Estimating influenza-associated mortality is important since seasonal influenza affects persons of all ages, causing severe illness or death. This study aimed to estimate influenza-associated mortality, considering both periodic changes and age-specific mortality by influenza subtypes.
Methods
Using the Microdata Integrated Service from Statistics Korea, we collected weekly mortality data including cause of death. Laboratory surveillance data of respiratory viruses from 2009 to 2016 were obtained from the Korea Centers for Disease Control and Prevention. After adjusting for the annual age-specific population size, we used a negative binomial regression model by age group and influenza subtype.
Results
Overall, 1 859 890 deaths were observed and the average rate of influenza virus positivity was 14.7% (standard deviation [SD], 5.8), with the following subtype distribution: A(H1N1), 5.0% (SD, 5.8); A(H3N2), 4.4% (SD, 3.4); and B, 5.3% (SD, 3.7). As a result, among individuals under 65 years old, 6774 (0.51%) all-cause deaths, 2521 (3.05%) respiratory or circulatory deaths, and 1048 (18.23%) influenza or pneumonia deaths were estimated. Among those 65 years of age or older, 30 414 (2.27%) all-cause deaths, 16 411 (3.42%) respiratory or circulatory deaths, and 4906 (6.87%) influenza or pneumonia deaths were estimated. Influenza A(H3N2) virus was the major contributor to influenza-associated all-cause and respiratory or circulatory deaths in both age groups. However, influenza A(H1N1) virus–associated influenza or pneumonia deaths were more common in those under 65 years old.
Conclusions
Influenza-associated mortality was substantial during this period, especially in the elderly. By subtype, influenza A(H3N2) virus made the largest contribution to influenza-associated mortality.

Summary

Korean summary
계절 인플루엔자는 심각한 호흡기 합병증으로 진행할 수 있어 질병 부담의 추산이 중요한 질병이다. 현재까지는 연령별, 인플루엔자 연관 사망을 정확하게 추산하기 어려웠으나, 본 연구에서는 이를 추산하기 위해 고안된 다양한 방법 중 음이항 회귀 분석을 이용하여 2009년부터 2016년간 인플루엔자 아형별 연관 사망을 추산하였다. 그 결과, 전체 사망자 중 65세 미만에서 약 6,774명, 65세 이상에서 약 30,414명의 연간 인플루엔자 사망이 추산되었고, 이는 특히 인플루엔자 아형 중 전체 연령에서 A(H3N2) 연관 사망이 가장 많은 비율을 차지했다.

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Special Article

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea: Jong-Myon Bae; J Prev Med Public Health. 2017;50(4):217-227. Published online June 16, 2017; DOI: https://doi.org/10.3961/jpmph.17.069

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Abstract PDF Supplementary Material

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

Summary

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Original Articles

Economic Burden of Colorectal Cancer in Korea: Ju-Young Byun, Seok-Jun Yoon, In-Hwan Oh, Young Ae Kim, Hye-Young Seo, Yo-Han Lee; J Prev Med Public Health. 2014;47(2):84-93. Published online March 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.2.84

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Abstract PDF

Objectives

The incidence and survival rate of colorectal cancer in Korea are increasing because of improved screening, treatment technologies, and lifestyle changes. In this aging population, increases in economic cost result. This study was conducted to estimate the economic burden of colorectal cancer utilizing claims data from the Health Insurance Review and Assessment Service.

Methods

Economic burdens of colorectal cancer were estimated using prevalence data and patients were defined as those who received ambulatory treatment from medical institutions or who had been hospitalized due to colorectal cancer under the International Classification of Disease 10th revision codes from C18-C21. The economic burdens of colorectal cancer were calculated as direct costs and indirect costs.

Results

The prevalence rate (per 100 000 people) of those who were treated for colorectal cancer during 2010 was 165.48. The economic burdens of colorectal cancer in 2010 were 3 trillion and 100 billion Korean won (KRW), respectively. Direct costs included 1 trillion and 960 billion KRW (62.85%), respectively and indirect costs were 1 trillion and 160 billion (37.15%), respectively.

Conclusions

Colorectal cancer has a large economic burden. Efforts should be made to reduce the economic burden of the disease through primary and secondary prevention.

Summary

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The Economic Burden of Epilepsy in Korea, 2010: Jaehun Jung, Hye-Young Seo, Young Ae Kim, In-Hwan Oh, Yo Han Lee, Seok-Jun Yoon; J Prev Med Public Health. 2013;46(6):293-299. Published online November 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.6.293

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Abstract PDF

Objectives

The purposes of this study were to evaluate the prevalence of epilepsy and to estimate the cost of epilepsy in Korea, 2010.

Methods

This study used a prevalence based approach to calculate the cost of epilepsy. Claims data from the Korean national health insurance and data from the Korea health panel, the Korea National Statistical Office's records of causes of death, and labor statistics were used to estimate the cost of epilepsy. Patients were defined as those who were hospitalized or visited an outpatient clinic during 2010 with a diagnosis of epilepsy (International Classification of Diseases 10th revision codes G40-G41). Total costs of epilepsy included direct medical costs, direct non-medical cost and indirect costs.

Results

The annual prevalence of treated epilepsy was 228 per 100 000 population, and higher in men. The age-specific prevalence was highest for teenagers. The total economic burden of epilepsy was 536 billion Korean won (KW). Indirect cost (304 billion KW) was 1.3 times greater than direct cost (232 billion KW). By gender, the male (347 billion KW) were more burdened than the female (189 billion KW). The estimated cost in young age younger than 20 years old was 24.5% of the total burden of epilepsy.

Conclusions

A significant portion of the economic burden of epilepsy is borne by people in young age. To reduce the economic burden of epilepsy, effective prevention and treatment strategies are needed.

Summary

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The Socioeconomic Burden of Coronary Heart Disease in Korea: Hoo-Sun Chang, Han-Joong Kim, Chung-Mo Nam, Seung-Ji Lim, Young-Hwa Jang, Sera Kim, Hye-Young Kang; J Prev Med Public Health. 2012;45(5):291-300. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.291

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Abstract PDF

Objectives

We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data.

Methods

A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective.

Results

Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556).

Conclusions

The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.

Summary

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English Abstracts

Socioeconomic Costs of Food-Borne Disease Using the Cost-of-Illness Model: Applying the QALY Method.: Hosung Shin, Suehyung Lee, Jong Soo Kim, Jinsuk Kim, Kyu Hong Han; J Prev Med Public Health. 2010;43(4):352-361.; DOI: https://doi.org/10.3961/jpmph.2010.43.4.352

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Abstract PDF

OBJECTIVES
This study estimated the annual socioeconomic costs of food-borne disease in 2008 from a societal perspective and using a cost-of-illness method. METHODS: Our model employed a comprehensive set of diagnostic disease codes to define food-borne diseases with using the Korea National Health Insurance (KNHI) reimbursement data. This study classified the food borne illness as three types of symptoms according to the severity of the illness: mild, moderate, severe. In addition to the traditional method of assessing the cost-of-illness, the study included measures to account for the lost quality of life. We estimated the cost of the lost quality of life using quality-adjusted life years and a visual analog scale. The direct cost included medical and medication costs, and the non-medical costs included transportation costs, caregiver's cost and administration costs. The lost productivity costs included lost workdays due to illness and lost earnings due to premature death. RESULTS: The study found the estimated annual socioeconomic costs of food-borne disease in 2008 were 954.9 billion won (735.3 billion won-996.9 billion won). The medical cost was 73.4 - 76.8% of the cost, the lost productivity cost was 22.6% and the cost of the lost quality of life was 26.0%. CONCLUSIONS: Most of the cost-of-illness studies are known to have underestimated the actual socioeconomic costs of the subjects, and these studies excluded many important social costs, such as the value of pain, suffering and functional disability. The study addressed the uncertainty related to estimating the socioeconomic costs of food-borne disease as well as the updated cost estimates. Our estimates could contribute to develop and evaluate policies for food-borne disease.

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Socioeconomic Costs of Stroke in Korea: Estimated from the Korea National Health Insurance Claims Database.: Seung ji Lim, Han joong Kim, Chung mo Nam, Hoo sun Chang, Young Hwa Jang, Sera Kim, Hye Young Kang; J Prev Med Public Health. 2009;42(4):251-260.; DOI: https://doi.org/10.3961/jpmph.2009.42.4.251

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OBJECTIVES
To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. METHODS: We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients' and caregivers' productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. RESULTS: A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. CONCLUSIONS: Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.

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Economic Burden of Cancer in South Korea for the Year 2005.: Jinhee Kim, Myung Il Hahm, Eun Cheol Park, Jae Hyun Park, Jong Hyock Park, Sung Eun Kim, Sung Gyeong Kim; J Prev Med Public Health. 2009;42(3):190-198.; DOI: https://doi.org/10.3961/jpmph.2009.42.3.190

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Abstract PDF

OBJECTIVES
The objective of this study is to estimate the economic costs of cancer on society. METHODS: We estimated the economic burden of people with cancer in South Korea. To perform the analysis, we reviewed the records of people who were cancer patients and those who were newly diagnosed with cancer. The data was compiled from the National Health Insurance Corporation, which included the insurance claims database, a list of cancer patients, a database that records the cancer rates, the Korea Central Cancer Registry Center's cancer patient registry database and the Korea National Statistical Office's causes of death database. We classified the costs as related to cancer into direct costs and indirect costs, and we estimated each cost. Direct costs included both medical and non-medical care expenses and the indirect costs consisted of morbidity, mortality and the caregiver's time costs. RESULTS: The total economic costs of cancer in South Korea stood at 14.1 trillion won in 2005. The largest amount of the cost 7.4 trillion won, was the mortality costs. Following this were the morbidity costs (3.2 trillion won), the medical care costs (2.2 trillion won), the non-medical care costs (1.1 trillion won) and the costs related to the caregiver's time (100 billion won). As a result, the economic cost of cancer to South Korea is estimated to be between 11.6 trillion won to 14.1 trillion won for the year 2005. CONCLUSIONS: We need to reduce the cancer burden through encouraging people to undergo early screening for cancer and curing it in the early stage of cancer, as well as implementing policies to actively prevent cancer.

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Original Article

Disability Weights for the Korean Burden of Disease Study: Focused on Comparison with Disability Weights in the Australian Burden of Disease Study.: Young Kyung Do, Seok Jun Yoon, Jung Kyu Lee, Young Hoon Kwon, Sang Il Lee, Changyup Kim, Kidong Park, Yong Ik Kim, Youngsoo Shin; J Prev Med Public Health. 2004;37(1):59-71.

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Abstract PDF: OBJECTIVE
This study aimed to measure the disability weights for the Korean Burden of Disease study, and to compare them with those adopted in the Australian study to examine the validity and describe the distinctive features. METHODS: The standardized valuation protocol was developed from the Global Burden of Disease (GBD) study and the Dutch Disability Weights study. Disability weights were measured for 123 diseases of the Korean version of Disease Classification by three panels of 10 medical doctors each. Then, overall distribution, correlation coefficients, difference by each disease, and mean of differences by disease group were analyzed for comparison of disability weights between the Korean and Australian studies. RESULTS: Korean disability weights ranged from 0.037 to 0.927. While the rank correlation coefficient was moderate to high (rs=0.68), Korean disability weights were higher than the corresponding Australian ones in 79.7% of the 118 diseases. Of these, war, leprosy, and most injuries showed the biggest differences. On the contrary, many infectious and parasitic diseases comprised the greater part of diseases of which Korean disability weights were lower. The mean of the differences was the highest in injuries of GBD disease groups, and in cardiovascular disease, injuries, and malignant neoplasm of the Korean disease category. CONCLUSION: Korean disability weights were found to be valid on the basis of overall distribution pattern and correlation, and are expected to be used as basic data for broadening the scope of burden of disease study. However, some distinctive features still remain to be explored in following studies.; Summary

Comparative Study

Disability Weights for Diseases in Korea.: Jung Kyu Lee, Seok Jun Yoon, Young Kyung Do, Young Hoon Kwon, Chang Yup Kim, Kidong Park, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 2003;36(2):163-170.

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Abstract PDF: OBJECTIVES
This study aimed to develop an evaluation protocol of disability weights using person trade-off, and to test the reliability of the developed protocol in a Korean context. METHODS: To develop the valuation protocol, the Global Burden of Disease (GBD) and the Dutch studies were replicated and modified. Sixteen indicator conditions were selected from the Korean version of disease classification, which was based on that of the GBD Study, and the person trade-off method referred to the Dutch method. RESULTS: The disability weights were valued in a two step panel study. The first step was a carefully designed group process by three panels, using person trade-off to establish the disability weights for sixteen selected indicator conditions. The second step consisted of interpolation of the remaining diseases, on a disability scale, by the individual members of three panels. The members of three panels were all medical doctors, with sufficient knowledge of the consequences of a broad variety of diseases. The internal consistency of the Korean disability weights was satisfactory. Considerable agreement existed within each panel and among the panels. CONCLUSIONS: It was feasible to use a modified evaluation protocol from those used in GBD and Dutch studies. This would provide a rational basis for an international comparative study of disability weights.; Summary

Original Article

Measuring the Burden of Major Cancers in Korea Using Healthy Life-Year (HeaLY).: Yong Jun Choi, Seok Jun Yoon, Chang Yup Kim, Youngsoo Shin; Korean J Prev Med. 2001;34(4):372-378.

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Abstract PDF: OBJECTIVES
This study introduced the healthy life-year(HeaLY), a composite indicator of disease burden, and used it to estimate the burden of major cancers in Korea. METHODS: We collected data from the national death certificate database, the national health insurance claims database and the abridged life table. This data was used to create a spreadsheet and estimate the burden of major cancers by sex in terms of HeaLYs. RESULTS: The burden of 10 major cancers for males was 2,248.97 person-year in terms of HeaLYs. Stomach cancer, liver cancer, and lung cancer were responsible for 75.2% of the burden of 10 major cancers The disease burden of 10 major cancers for females was estimated to be 1,567.58 person-years. About two thirds of HeaLYs lost were from stomach cancer, liver cancer, lung cancer, colorectal cancer, and breast cancer. The rankings among 10 major cancers were somewhat different in terms of both HeaLYs and deaths as the HeaLY method considers both mortality and morbidity. CONCLUSIONS: Despite the limitations of the data sources, we conclude that HeaLY can aid in setting policy priorities concerning major cancers by estimating the disease burden of these cancers. Time-series analysis of the disease burden using HeaLY and DALY will elucidate the strengths and weaknesses of both methods.; Summary

English Abstract

The Socioeconomic Cost of Diseases in Korea.: Young Ho Jung, Sukja Ko; J Prev Med Public Health. 2006;39(6):499-504.

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Abstract PDF: OBJECTIVES
The aim of the study was to estimate the annual socioeconomic cost of diseases in Korea. METHODS: We estimate both the direct and indirect costs of diseases in Korea during 2003 using a prevalence-based approach. The direct cost estimates included medical expenditures, traffic costs and caregiver's cost, and the indirect costs, representing the loss of production, included lost workdays due to illness and lost earnings due to premature death, which were estimated based on the human capital theory. The cost estimates were reported at three different discount rates (0, 3 and 5%). RESULTS: The cost of diseases in Korea during 2003 was 38.4 trillion won based on 0% discount rate. This estimate represents approximately 5.3% of GDP. The direct and indirect costs were estimated to be 22.5 trillion (58.5% of total cost) and 15.9 trillion won (41.5%), respectively. It was also found that the cost for those aged 40~49 accounted for the largest proportion (21.7%) in relation to age groups. The cost of diseases for males was 23.5% higher than that for females. For major diseases, the total socioeconomic costs were 16.0, 13.4, 11.3 and 11.19% for neoplasms, and diseases of the digestive, respiratory and circulatory systems, respectively. CONCLUSIONS: This study can be expected to provide valuable information for determining intervention and funding priorities, and for planning health policies.; Summary

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