Korean J Hepatol > Volume 17(4); 2011 > Article
Lee, Chung, and Hyun: Socioeconomic costs of liver disease in Korea

ABSTRACT

Background/Aims

This study analyzed the scale and trends of the social and economic costs of liver disease in Korea for the past 5 years.

Methods

The social aspects of socioeconomic costs were projected for viral hepatitis (B15-B19), liver cirrhosis, malignant neoplasm of the liver (C22) and other liver diseases (K70-K76), as representative diseases by dividing costs into direct and indirect from 2004 to 2008. Direct costs include hospitalization, outpatient, and pharmacy costs in the health-care sector, and transportation and caregiver costs. Indirect costs include the future income loss due to premature death and the loss of productivity resulting from absence from work.

Results

The social and economic costs of liver disease were projected to be KRW 5,858 billion in 2004, KRW 5,572 billion in 2005, KRW 8,104 billion in 2006, KRW 6,095 billion in 2007, and KRW 5,689 billion in 2008. The future income loss resulting from premature death is thus greatest, from 73.9% to 86.1%, followed by the direct medical costs, from 9.0% to 18.1%. The productivity loss resulting from absence from work accounts for 3.3-5.5%, followed by the direct nonmedical costs such as transportation and caregiver costs, at 1.5-2.5%.

Conclusions

Among the socioeconomic costs of liver disease in Korea, the future income loss resulting from premature death is showing a decreasing trend, whereas direct medical costs are increasing dramatically.

INTRODUCTION

As the human life span has been extended with the development of medicine, chronic diseases rather than acute ones have been increasing. Because it is hard to cure chronic liver disease completely and it should be controlled well for life, patients and their family members bear various burdens. Liver disease, one of the most representative chronic diseases, has showed a high prevalence rate in the East including South Korea and it includes chronic hepatitis, hepatic cirrhosis and hepatocellular carcinoma (HCC).
Liver disease ranked the eighth among causes of death in South Korea in 2009, and 6,868 died of liver disease for the one year.1 It recorded adds the cause of fifth in males and did third in persons in their 40s. Moreover, the mortality rate of HCC showed the second highest level by following lung cancer and it did the highest in persons in their 40s and 50s.1 In particular, a study estimating socioeconomic costs of major cause of death in South Korea revealed that the loss of productivity caused by premature death due to chronic liver disease ranked second next to that of cancer.2 The high mortality of liver disease in economically active persons in their 40s and 50s means that the importance of liver disease management should be recognized by considering that chronic liver disease influences not only individuals or families but also the productivity of a society.3
The cost of illness is one of the most initial economic evaluation methods in the healthcare and it aims to measure the economic burden of illness in a society in terms of the consumption of healthcare resources and the loss of productivity.4 In addition, studies on the cost of illness suggest the negative influence of illness and injury by using a monetary unit which is a universal language of decision-makers and policy-makers. However, their results can provoke a considerable difference by countries, a base year for estimation, types of disease, cost items, formulas for estimation and data for analysis among researchers and can have problem relating to validity or reliability.5,6 Nonetheless, studies on the cost of illness have been utilized as important indexes to prioritize the economic burdens of specific diseases, to determine the priority of research and development in National Institutes of Health, Institute of Medicine, the national assembly and others.6
Most previous studies on the cost of illness have dealt with major health risks like specific diseases2,7,8 or smoking,9-12 alcohol-drinking13-15 and obesity16-18 and their relevant diseases. But, even though liver disease exerts not a few negative effect in South Korea with recording a high mortality rate especially in economically active age groups as one of major death causes, there has been nearly no study analyzing the socioeconomic burden of liver disease precisely in the country. Therefore, this study aims to estimate the socioeconomic costs of major liver diseases (viral infection, liver cirrhosis and others and HCC) for the last five years (2004-2008) to provide basic data for the public awareness of the importance of prevention and management of liver disease.

MATERIALS AND METHODS

Materials

Studies on the cost of illness have been described by several researchers since 1960s.6,19-21 Generally, studies on the cost of illness divide costs into direct, indirect and intangible ones and their viewpoints include a society, governmental institutions, employers, program providers and others. Most studies have measured the cost of illness from a societal perspective to consider its overall change comprehensively.22 This study selected viral hepatitis (B15-B19), liver cirrhosis and others (K70-K76) and HCC (C22) (Table 1) as representative liver diseases, and estimated their socioeconomic costs in 2004 to 2008 by classifying them into direct and indirect costs.

Direct costs

The direct costs included direct medical costs and direct non-medical costs. The direct medical costs meant the sum of medical costs paid by outpatients and inpatients at medical institutions and at pharmacies to treat the liver disease. The total scale of treatment amount of Korean patients with liver disease can be investigated with health insurance data for items covered by the insurance at medical institutions and pharmacies. As the whole nation has been mandatorily insured through the national health insurance and a single system of health insurance claim data has been established in South Korea, various studies on cost of illness be conducted easily without an additional survey.23,24 This study estimated the medical costs for items covered by the insurance by calculating the treatment amount of liver disease for inpatients and outpatients at medical institutions and at pharmacies by gender, age and year based on the National Health Insurance Statistical Yearbook (Appendix 1).25
By considering that the rate of uninsured out-of-pocket payments was 15.2%26 in 2008, the exclusion of uninsured items underestimates the direct medical costs eventually not to reflect a socioeconomic loss related with liver disease. Therefore, for uninsured items, the medical costs among direct medical costs were estimated by applying the copayment rate of non-benefit (Appendix 2) for the total treatment amount for inpatients and outpatients at medical institutions and at pharmacies to the total treatment amount of liver disease by gender, age and year.26
The direct non-medical costs meant incidental expenses for the use of medical institutions or pharmacies, traffic costs for visits to clinics and costs of caregivers for inpatients. As the length of hospitalization and visiting days for medical service can be investigated as a whole, health insurance data are the most objective and comprehensive data to calculate direct non-medical costs. The traffic costs were estimated by multiplying the number of visit days of liver disease patients by gender and age by an average round-trip traffic cost per one visit. At this time, the number of visit days by gender and age was gained from the National Health Insurance Statistical Yearbook25 (Appendix 3) and the average round-trip traffic cost was calculated to be KRW 1,191, KRW 1,251, KRW 1,309, KRW 1,356 and KRW 1,475 in 2005 to 2008, respectively by applying the consumer price index of traffic costs27 to the average round-trip traffic cost per one visit to an outpatient clinic (KRW 1,475) in 2008 Korean Health Panel Survey.28 In addition, costs of caregivers were regarded as personnel expenses of caregivers and opportunity costs of guardians of inpatients. The number of hospitalization days due to liver disease by gender and age was obtained from the National Health Insurance Statistical Yearbook25 (Appendix 3) and the daily average personnel expenses of caregivers (KRW 60,000) suggested by Korean caregiver societies was input as the personnel expenses of caregivers or the opportunity costs of guardians. The costs of caregivers of the patients were estimated by multiplying the personnel expenses by the number of hospitalization days.

Indirect costs

Indirect costs included lost earnings due to premature death caused by liver disease and loss of productivity following absences from work to visit medical institutions. The lost earnings due to premature death was estimated by multiplying the human loss per person by the number of deaths due to liver disease by gender and age and the period from the year after death to the average life expectancy by gender and age. The number of deaths due to liver disease was secured from Annual Report on the Cause of Death Statistics (Appendix 4) published annually by Statistics Korea. The human loss per person was calculated with the probability of survival, employment rate, average annual income and wage growth rate by gender and age in each year from the year after death to the average life expectancy (Appendix 5). Therefore, the lost earnings due to premature death was estimated with the number of deaths by gender and age from Annual Report on the Cause of Death Statistics,29 the average life expectancy and the survival rate by gender and age from Life Table,30 the employment rate by gender and age from Annual Report on the Economically Active Population Survey,31 the average annual real wage by gender and age from Basic Survey on Wage Structure32 and the real wage growth rate of industry by gender and age from Survey Report on the Wages and Working Hours at Establishments.33 At this time, this study applied a discount rate to convert future costs after premature death into the present values in each year and it reflected an individual time preference or an interest rate. The future costs were changed into the present values by dividing them by 5% discount rate.
The loss of productivity following absences from work to visit medical institutions to treat liver disease was calculated by gaining the numbers of hospitalization days and visit days due to liver disease by gender, age and year from the National Health Insurance Statistical Yearbook25 (Appendix 3) and by multiplying the numbers by the average daily income by gender, age and year from Basic Survey on Wage Structure.32 Cost items for estimation, major indexes to calculate each cost item and sources of indexes are summarized in Table 2.

Methods

Direct costs (DC) consisted of direct medical costs such as expenses of insured and uninsured items for inpatients and outpatients at medical institutions and at pharmacies to treat liver disease and direct non-medical costs like traffic costs to visit medical institutions and costs of caregivers for inpatients. Therefore, as shown in the following formulas for estimation, the direct medical costs were estimated by summing the total treatment amount of inpatients (IP) and outpatients (OP) and at pharmacies (P) based on the health insurance data by gender, age and disease (Appendix 1) and the value of multiplying the total treatment amount by the rate of uninsured out-of pocket payments to the total treatment amount of each group (α, β, γ) (Appendix 2). In addition, the traffic costs were obtained by multiplying the number of visit days (OV) by gender, age and disease (Appendix 3) by the average round-trip traffic costs per one visit to outpatient clinic (MT), and the costs of caregivers were done by multiplying the number of hospitalization days by gender, age and disease (IV) (Appendix 3) by the daily average personnel expenses of caregivers (MC).

kjhep-17-274-e001.jpg
  • DC = direct costs

  • i = 1, 2, ..., n disease, j = 1, 2 gender, k = 0, 1, ..., n age

  • IPijk = total treatment amount of inpatients of i, j and k in health insurance data

  • OPijk = total treatment amount of outpatients of i, j and k in health insurance data

  • Pijk = total treatment amount at pharmacies of i, j and k in health insurance data

  • α = rate of uninsured out-of pocket payments to total treatment amount of inpatients

  • β = rate of uninsured out-of pocket payments to total treatment amount of outpatients

  • γ = rate of uninsured out-of pocket payments to total treatment amount at pharmacies

  • OVijk = number of visit days of i, j and k

  • MTj = average round-trip traffic costs per one visit to an outpatient clinic of j

  • IVijk = number of hospitalization days of i, j and k, MC = daily average costs of caregivers

Indirect costs included the lost earnings due to premature death by liver disease and the loss of productivity following absences from work to visit medical institutions. The lost earnings due to premature death could be determined by how to measure the human value and methods for the measurement were gross loss of output or human capital approach and net loss of output approach. The former converts the total labor income of premature deaths into the present value and the latter deducts future consumption from the estimate of the former.
Future income of premature deaths was estimated by applying the most common gross loss of output or human capital approach.34 So, the lost earnings of premature deaths due to liver disease were calculated by multiplying the human loss by gender and age (Appendix 5) obtained with the survival rate by gender and age (S), the employment rate (E), the yearly average real wage (YW), the real wage growth rate (WR) and the discount rate (r) by the number of deaths due to liver disease by gender, age and disease (D) (Appendix 4).

kjhep-17-274-e002.jpg
The loss of productivity following absences from work to visit medical institutions to treat liver disease (PLC) was estimated by multiplying the sum of the number of hospitalization days by gender, age and disease (IV) and a third of the number of visit days (OV) (Appendix 3) by the employment rate by gender and age (E) and the daily average wage by gender and age (DW). At this time, to revise the difference in the loss of productivity between outpatients and inpatients, the rate of physician productivity for outpatients to that for inpatients suggested by Noh et al14 and Jung and Ko2 was applied. The number of non productive days was calculated by adding one third of the number of visit days to the number of hospitalization days.

kjhep-17-274-e003.jpg
  • PLC = loss of productivity following sick leave

  • i = 1, 2, ..., n disease, j = 1, 2 gender, k = 0, 1, ..., n age

  • IVijk = number of hospitalization days of i, j and k

  • OVijk = number of visit days of i, j and k

  • Ejk = employment rate of j and k

  • DWjk = daily average wage of j and k

RESULTS

Direct costs

The medical costs of inpatients and outpatients at medical institutions and at pharmacies to treat liver disease or the sum of benefits paid by the insurer, legal out-of pocket payments and uninsured out-of pocket payments, increased 1.8 times from KRW 588.7 billion in 2004 to KRW 1,032.2 billion in 2008. For the costs by gender, those of males became 1.7 times from KRW 417.5 billion to KRW 724.3 billion and those of females did 1.8 times from KRW 171.2 billion to KRW 307.9 billion, respectively for the same period. The medical costs of males and females accounted for 70.2% and 29.8% of the total costs, respectively in 2008 and the rate of males was 2.4 times higher than that of females. The rate of medical costs by age recorded the highest level or 27.0-28.7% in the patients in their 50s, and those in their 40s (21.3-23.5%), 60s (21.1-22.0%), 30s (10.7-11.0%) and 70s (8.4-9.5%) (Table 3).
Traffic costs went up 1.3 times from KRW 5.5 billion in 2004 to KRW 7 billion in 2008. The traffic costs of males increased 1.3 times from 3.6 to KRW 4.5 billion and those of females did from KRW 1.9 billion to KRW 2.5 billion, respectively for the same period. The rate of traffic costs was found to be 1.8 times higher in males than in female by recording 64.4% and 35.6%, respectively in 2008. The traffic costs by age accounted for the largest portion or 23.1-25.6% in liver disease patients in their 40s, and those in their 50s (21.8-24.6%), 30s (15.8-17.1%), 60s (15.7-16.7%) and 20s (8.7-9.4%) (Table 4).
The personnel expenses of paid caregivers or the opportunity costs of guardians to care inpatients with liver disease increased 1.2 times from KRW 111.5 billion in 2004 to KRW 133 billion in 2008. The costs of males became higher 1.2 times from KRW 82.9 billion to KRW 95.4 billion and those of females did 1.3 times from KRW 28.6 billion to KRW 37.7 billion, respectively. In addition, the rates of costs of caregivers in male patients recorded 71.7% and 28.3%, respectively in 2008 and the rate of males was 2.5 times higher than that of females. The rate of costs of caregivers by age showed the highest level or 24.3-26.5% in the patients in their 50s, and those in their 60s (21.1-22.1%), 40s (18.8-23.7%), 70s (10.0-13.1%) and 30s (9.4-10.8%) (Table 5).

Indirect costs

Indirect costs included the lost earnings due to premature death caused by liver disease and the loss of productivity following absences from work. The lost earnings due to premature death reduced from KRW 4,925 billion in 2004 to KRW 4,205.1 billion in 2008 by 14.6% and the lost earnings of males declined from KRW 4,623.7 billion to KRW 3,934.5 billion by 14.9% and those of females did from KRW 301.4 billion to KRW 270.6 billion by 10.2%, respectively. The rates of lost earnings in males and females with liver disease were 93.6% and 6.4%, respectively in 2008, so the rate of males was 14.5 times higher than that of females. The rate by age recorded the highest level or 39.4-44.0% in liver disease patients in their 40s, and those in their 50s (21.1-33.9%), 30s (9.1-22.2%), 60s (7.9-13.1%) and 70s (1.1-3.5%). This showed the premature deaths in economically active age groups provoked a significant social loss of productivity (Table 6).
The scale of loss of productivity following absences from work to treat liver disease went up 1.4 times from KRW 227.3 billion in 2004 to KRW 311.2 billion in 2008 and the scale of males was raised 1.3 times from KRW 183.8 billion to KRW 247.6 billion and those of females was 1.5 times from KRW 43.5 billion to KRW 63.6 billion, respectively for the same period. The rates of loss of productivity in males and females accounted for 79.6% and 20.4%, respectively in 2008 and that of males was found to be 3.9 times higher than that of females. The loss of productivity by age recorded the highest level or 27.0-32.1% in liver disease patients in their 40s, and those in their 50s (26.7-30.0%), 60s (14.1-15.2%), 30s (13.9-15.4%) and 70s (5.7-7.9%) (Table 7).

Overall costs

When all socioeconomic costs of liver disease for the last five years were put together, they recorded KRW 5,858 billion, KRW 5,572.4 billion, KRW 8,104.3 billion, KRW 6,095.2 billion and KRW 5,688.6 billion in 2004 to 2008, respectively. According to cost items, the lost earnings caused by liver disease-related premature death accounted for the largest portion of the total socioeconomic costs or 73.9-86.1%, and the rates of direct medical costs, the loss of productivity following sick leave and direct non-medical costs such as traffic costs and costs of caregivers were 9.0-18.1%, 3.3-5.5% and 1.5-2.5%, respectively. In particular, the rate of lost earnings out of the total socioeconomic costs slightly decreased from 2004 to 2008 but the rate of direct medical costs or costs paid by health insurance sharply increased (Table 8).
Analysis on the socioeconomic costs of liver disease by gender and age revealed that 88.0-90.7% of the total costs were incurred in males, and the rate of patients with liver disease in their 40s showed the highest (34.9-41.2%) and the rates of those in their 50s and 30s followed it by recording 22.0-32.4% and 9.8-20.7%, respectively. The costs of males were higher in those in their 40s (36.7-42.7%), 50s (21.8-33.3%) and 30s (9.5-21.2%) in the order and those of females were higher in those in their 50s (23.8-26.2%), 40s (22.3-26.5%) and 60s (17.8-20.9%) in the order (Table 9).

DISCUSSION

Liver disease is one of major death causes in South Korea and the number of deaths caused by it tends to be high in economically active age groups as a representative disease provoking a significant loss of productivity due to premature death. In 2001, liver disease ranked fifth among death causes in South Korea but its loss of productivity due to premature death was found to be the highest except cancer which is the number one death cause. Although liver disease leads to a considerable socioeconomic loss in the country like this, basic studies to establish liver disease-related health insurance policies are insufficient. Therefore, this study was conducted to provide basic data for policy making for the prevention and the management of liver disease in the future by estimating the socioeconomic costs of major liver diseases for the last five years from a societal perspective.
Liver diseases analyzed in this study were viral hepatitis (B15-B19), liver cirrhosis and other liver disease (K70-K76) and HCC (C22) and the costs of them were estimated by dividing them largely into direct and indirect costs. The directs costs contained the treatment amount covered and not covered by health insurance for inpatients and outpatients at medical institutions and at pharmacies, the traffic costs to visit medical institutions and the personnel expenses of caregivers or the opportunity costs of guardians for inpatients. The indirect costs did the lost earnings caused by liver disease-related premature death and the loss of productivity following absences from work to visit medical institutions.
According to the results, the socioeconomic costs of liver disease were estimated to be KRW 5,858 billion, KRW 5,572.4 billion, KRW 8,104.3 billion, KRW 6,095.2 billion and KRW 5,688.6 billion from 2004 to 2008, respectively. By the cost items, the lost earnings caused by liver disease-related premature death accounted for the largest portion of the total costs or 73.9-86.1%, and the direct medical costs (9.0-18.1%), the loss of productivity following sick leave (3.3-5.5%) and the traffic costs and the costs of caregivers (1.5-2.5%) followed it in the order. Out of the total socioeconomic costs of liver disease, 88.0-90.7% were incurred in males, and the costs by age showed higher rate in the patients in their 40s (34.9-41.2%), 50s (22.0-32.4%) and 30s (9.8-20.7%) in the order.
A study of Jung and Ko2 estimated the socioeconomic costs of the top five diseases for death causes in South Korea by classifying the costs into direct and indirect costs. In their study, the direct costs included medical expenditures, traffic costs and costs of guardians and the indirect costs did costs of lost workdays due to illness and lost earnings due to premature death. They reported that the costs of cancer (malignant neoplasm) or number one death cause, cerebrovascular disease, heart disease, diabetes and liver disease were KRW 7,735.8 billion, KRW 2,313.8 billion, KRW 2,141.7 billion, KRW 1,158.8 billion and KRW 2,620.1 billion, respectively. For liver disease, the lost earnings due to premature death accounted for 88.3% of the total costs and rates of the medical expenditures of inpatients and outpatients, the costs of lost workdays, the costs of caregivers and the traffic costs recorded 7.7%, 2.4%, 1.1% and 0.5%, respectively.
In the comparison of the results between their study and this one, the study of Jung and Ko2 showed that the socioeconomic costs of liver disease were estimated to be KRW 2,620.1 billion in 2001 while this study found that the costs were done to be KRW 5,858 billion in 2004, so the difference in the costs was significant. That is considered to result from not only the difference in the year of estimation and the methodologies but also the exclusion of the costs at pharmacies, which accounted for a considerable portion in the total costs, in the study of Jung and Ko.2 But, the finding that the rate of lost earnings due to premature death recorded the highest level among the socioeconomic costs of liver disease and the lost earnings by age showed the highest rates in economically active persons in their 30s, 40s and 50s, tended to be similar in both of the two studies and it led to a large influence on the loss of productivity in the society at large.
In addition, studies estimating the socioeconomic costs of disease have been reported continuously in Canada since 1986. A study calculating the socioeconomic costs by classifying total disease into 20 groups such as cardiovascular disease, musculoskeletal disease and cancer with the data in 1998 was published.34 The study in Canada34 largely divided the costs of diseases into direct and indirect costs, and the direct costs included treatment amount at medical institutions, drug expenditures and doctor bills and the indirect costs contained death costs and costs of prevalence of short- and long-term disorder. According to its results, although it did not examine liver disease specifically, the direct and indirect costs of the digestive disease including liver disease accounted for 4.2% (USD 3.54 billion) and 3.1% (USD 2.31) of the costs of total diseases and their sum recorded 7.3% (USD 5.85 billion). As the study in Canada found that the weight of direct costs incurred by visiting medical institutions directly to treat digestive disease were estimated to be larger than that of indirect costs such as death costs, the finding was different from that of Korean studies investigating only liver disease.
This study is meaningful as the latest study on estimation of the socioeconomic costs of liver disease for the longest period. Moreover, because it calculated the costs from a societal perspective, it included the extensive effect of liver disease on the society at large. In particular, all Koreans have been insured mandatorily and the country has established a single insurance claim system so that the total scale of healthcare utilization except uninsured items can be grasped when liver disease patients utilize medical institutions or pharmacies. As this study used these health insurance data to estimate direct medical costs, direct non-medical costs (traffic costs, costs of caregivers) and the loss of productivity following sick leave, the validity and the reliability of results of this study were expected to be enhanced. However, for direct medical costs, uninsured items not paid by the health insurance system needed to be included to calculate actual costs exactly but this study gained the uninsured medical costs by estimating them with the rate of uninsured out-of pocket payments26 in South Korea published by National Health Insurance Corporation every year since 2004. But, the data had a limitation that they did not include those about packs of prepared herb medicine in the oriental medicine and health improving agents like vitamin supplements at pharmacies. Although this study utilized the best available data and methodology to enhance the reliability and the utilization of the results, it had some limitations as follows.
First, in the process of investigating the healthcare utilization with the health insurance data related to liver disease, the data were extracted with only principal diagnosis as a standard with excluding liver disease as additional diagnosis, so the directs costs and the loss of productivity following sick leave could be underestimated. Second, costs of driving cars to visit outpatient clinics due to liver disease were excluded from the mean traffic costs so that the average round-trip traffic costs per one visit to an outpatient clinic could be underestimated. Third, for costs of caregivers for inpatients with liver disease, the nursing of guardians or paid caregivers might be determined by the severity of disease and the costs of caregivers could be incurred at home as well as at medical institutions. However, because of no data about the rate of the care-giving at home and the correlation between the severity of disease and the utilization rate of care-giving service, this study limited cases to calculate the costs of caregivers to inpatients at medical institutions, so the costs of caregivers was estimated on the assumption that the inpatients needed full-time care-giving. Fourth, in the process of estimating the future income loss due to premature death caused by liver disease and the loss of productivity following sick leave, this study analyzed only employees with income except unemployed persons (job seekers) and economically inactive population (housewives, students and persons waiting to enter the army) among the working-age group aged over 15 years to calculate the scale of objective and valid income loss. So, the exclusion of unpaid productive activities of unemployed persons and economically inactive population could underestimate the loss of productivity following premature deaths and sick leave, but objective and valid data to investigate the rate of the population and the economic value of the unpaid activities were insufficient. Fifth, the loss of productivity following sick leave contained the decreased or lost income of employed liver disease patients due to hospitalization or visits to medical institutions. However, a simple rest at home or other places during sick leave by the severity of disease was excluded in this study because of no data about the population, so the loss of productivity following sick leave could be underestimated. Lastly, the health insurance data are collected based on claims submitted to National Health Insurance Corporation by healthcare providers to receive costs paid by the insurer among the total costs of patients. Therefore, validity issues related with diagnosis and the content of medical service in the health insurance data have been raised continuously and particularly up-coding of reporting wrong disease codes intentionally works as a factor hampering the reliability of studies using the data. However, despite these fundamental limitations of the health insurance data, this study is considered to have relatively less up-coding inducing factors by analyzing liver disease or one of comparatively severe diseases and some up-coding related errors within liver disease are thought not to influence the results of this study considerably because this study analyzed the total liver disease not a part of the disease.
In conclusion, the socioeconomic costs of liver disease, although they were slightly different by year, were as much as maximally KRW 8,104.3 billion in 2006. The lost earnings caused by liver disease-related premature deaths accounted for the largest portion or 73.9-86.1%. However, while the rate of lost earnings tended to reduce slightly from 2004 to 2008, the rate of direct medical costs paid by health insurance increased sharply. These findings meant that measures to improve the efficiency of the medical costs of liver disease are necessary.
Moreover, 88.0-90.7% out of the socioeconomic costs of liver disease were incurred in males, and the costs by age recorded the highest rate or 34.9-41.2% of the total costs in liver disease patients in their 40s and those in their 50s (22.0-32.4%) and 30s (9.8-20.7%) followed them in the order. That shows that liver disease provokes a significant loss in most economically active age groups, and if appropriate measures for the management of liver disease are not prepared, not only the loss of productivity in the society at large but also various potential loss are expected to be raised. Lastly, the results of this study are considered to be useful for promoting the public awareness of the urgency of the prevention and the management of liver disease and for prioritizing disease-related policies in various health projects.

Acknowledgements

This study was supported by Health Insurance Policy Research Institute, National Health Insurance Corporation.

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APPENDICES

Appendix 1

Cost of treatment related to liver disease (units: KRW 1,000,000)*


kjhep-17-274-a001.jpg
*source: National health insurance corporation, Health Insurance Review & Assessment Service (2005-2009).25

Appendix 2

Ratio of treatment cost to nonbenefit cost (unit: %)*


kjhep-17-274-a002.jpg
*source: Choi et al (2009).26

Appendix 3

Visit days related to liver disease (units: days)*


kjhep-17-274-a003.jpg
*source: National health insurance corporation, Health Insurance Review & Assessment Service (2005-2009).25

Appendix 4

Deaths related to liver disease (units: persons)*


kjhep-17-274-a004.jpg
*source: Statistics Korea (2005-2009).29

Appendix 5

Human capital loss per capita stratified according to sex, age, and year (units: KRW 1,000)


kjhep-17-274-a005.jpg
Table 1
Categories of liver disease

kjhep-17-274-i001.jpg
Table 2
Categories related to liver disease and data sources

kjhep-17-274-i002.jpg

*It is composed costs burdened by insurer and by beneficiary.

Table 3
Direct medical costs related to liver disease (units: KRW 1,000,000, %)

kjhep-17-274-i003.jpg
Table 4
Transportation costs related to liver disease (units: KRW 1,000,000, %)

kjhep-17-274-i004.jpg
Table 5
Caregiver costs related to liver disease (units: KRW 1,000,000, %)

kjhep-17-274-i005.jpg
Table 6
Future income loss due to premature death related to liver disease (units: KRW 1,000,000, %)

kjhep-17-274-i006.jpg
Table 7
Productivity loss resulting from absence from work related to liver disease (units: KRW 1,000,000, %)

kjhep-17-274-i007.jpg
Table 8
Socioeconomic costs of liver disease (units: KRW 1,000,000, %)

kjhep-17-274-i008.jpg

*It is composed costs burdened by insurer and by beneficiary.

Table 9
Socioeconomic costs of liver disease stratified according to sex and age group (units: KRW 1,000,000, %)

kjhep-17-274-i009.jpg

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