Simulating lifestyle and medical interventions to prevent type-2 diabetes: an economic evaluation for Belgium.

By 2040, over half a billion people globally are expected to have diabetes. This disease implies a loss in life quality and comes with a significant financial impact. To avoid prevalence increases in the main category of diabetes-type-2 diabetes (T-2D)-, preventive action among high-risk groups is necessary. Lifestyle and medical interventions with metformin among prediabetic individuals show strong potential to decrease or delay T-2D. The aim of this paper is to evaluate the cost-effectiveness and budget impact of a nation-wide implementation of these interventions, between 2020 and 2040, in Belgium. This is done through a dynamic, non-homogeneous, semi-Markov model which simulates prevalence and costs of a type of prediabetes (impaired glucose tolerance or IGT) and T-2D in Belgium. High-risk individuals are first screened; individuals with IGT then enroll in a lifestyle or metformin program. Compared to no intervention, both programs are very cost effective from the perspective of the health care system and cost-saving from a broader societal perspective. Both interventions require an initial, affordable government investment and later yield government savings. The lifestyle program is a cost-effective alternative to the metformin intervention and may yield additional benefits through, for example, improvements in mental health.

The financial burden of non-communicable diseases in the European Union: a systematic review.

BACKGROUND: Non-communicable diseases (NCDs) impose a significant and growing burden on the health care system and overall economy of developed (and developing) countries. Nevertheless, an up-to-date assessment of this cost for the European Union (EU) is missing from the literature. Such an analysis could however have an important impact by motivating policymakers and by informing effective public health policies. METHODS: Following the PRISMA protocol, we conduct a systematic review of electronic databases (PubMed/Medline, Embase, Web of Science Core Collection) and collect scientific articles that assess the direct (health care-related) and indirect (economic) costs of four major NCDs (cardiovascular disease, cancer, type-2 diabetes mellitus and chronic respiratory disease) in the EU, between 2008 and 2018. Data quality was assessed through the Newcastle-Ottawa Scale. RESULTS: We find 28 studies that match our criteria for further analysis. From our review, we conclude that the four major NCDs in the EU claim a significant share of the total health care budget (at least 25% of health spending) and they impose an important economic loss (almost 2% of gross domestic product). CONCLUSION: The NCD burden forms a public health risk with a high financial impact; it puts significant pressure on current health care and economic systems, as shown by our analysis. We identify a further need for cost analyses of NCDs, in particular on the impact of comorbidities and other complications. Aside from cost estimations, future research should focus on assessing the mix of public health policies that will be most effective in tackling the NCD burden.

Tackling the chronic disease burden: are there co-benefits from climate policy measures?

Each year, non-communicable diseases (NCDs) kill 40 million people worldwide and impose an estimated economic burden of $600 billion. Without effective policymaking, NCDs will continue to undermine health and economic systems globally. We propose that climate policy measures-such as carbon pricing-can yield significant health-related co-benefits aside from their intended greenhouse gas emission reduction. We simulate three carbon tax scenarios in the energy and food sector in Belgium and assess the resulting health-related co-benefits. These benefits originate from decreased exposure to two leading NCD risk factors: fine particulate matter and dietary regimes excessive in animal products. The carbon tax could prevent 42,300-78,800 Disability-Adjusted Life Years in Belgium, or save 0.6-1.1% of total health care expenditure and an additional 0.06-0.12% of Belgian GDP. We conclude that these health-related co-benefits should be included in the cost-benefit analysis of carbon pricing.

First depressed, then discriminated against?

Each year a substantial share of the European population suffers from major depression. This mental illness may affect individuals' later life outcomes indirectly by the stigma it inflicts. The present study assesses hiring discrimination based on disclosed depression. To this end, between May 2015 and July 2015, we sent out 288 trios of job applications from fictitious candidates to real vacancies in Belgium. Within each trio, one candidate claimed to have become unemployed only recently, whereas the other two candidates revealed former depression or no reason at all for their unemployment during a full year. Disclosing a year of inactivity due to former depression decreases the probability of getting a job interview invitation by about 34% when compared with candidates who just became unemployed, but the stigma effect of a year of depression is not significantly higher than the stigma effect of a year of unexplained unemployment. In addition, we found that these stigmas of depression and unemployment were driven by our male trios of fictitious candidates. As a consequence, our results are in favour of further research on gender heterogeneity in the stigma of depression and other health impairments.