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Life and Economic Impact of Lung Disease in Ontario: 2011 to 2041

Background:
Asthma, chronic obstructive pulmonary disease (COPD) and lung cancer are highly prevalent in Ontario and a leading cause of disability, suffering and health care service use. The aging of the Ontario population coupled with risk factors such as smoking, has led to lung disease becoming one of the key challenges facing society. Prevalence estimates suggest that over 2.4 million Ontarians currently have some form of lung disease, representing 18.2% of the Ontario population. In 2011, the growing burden on health care and social service systems in Ontario is estimated to be $1.6 billion, $3.3 billion and $158.6 million in direct health care costs alone, for asthma, COPD and lung cancer, respectively. The total economic burdens (direct and indirect costs) for asthma, COPD and lung cancer are estimated to be over $1.8 billion, $3.9 billion and $293.9 million, respectively. The life and economic consequences of lung disease will be further magnified over the next 30 years due to the increase in the expected number of people living with these conditions.

This is estimated to be more than 3.6 million people within one generation, representing 20.5% of the Ontario population. As a result of the increasing number of people living with lung disease, the associated economic burden is also expected to increase; the cumulative 30 year total economic burden of asthma, COPD and lung cancer is expected to exceed $96.7 billion, $310.7 billion and $33.5 billion in 2011 present value dollars, respectively.

Study Objective:
The objective of this study was to estimate the health and economic burden of asthma, COPD and lung cancer in Ontario, beginning in 2011 and annually over the next 30 years. The 30 year baseline assessment is then used to assess the impact of lung disease prevention, treatment and care interventions on reducing the baseline burden.

Methods:
Using RiskAnalytica’s Life at Risk® simulation platform, measures of incidence, prevalence and mortality were simulated to estimate the burden of lung disease over a 30 year time horizon, using input data for asthma, COPD, and lung cancer. These outcomes were then mapped to estimates of health care utilization and workplace productivity to simulate the economic burden of lung disease. Throughout this study, an independent panel of recognized lung disease epidemiologists, researchers, clinicians and respirologists was consulted to review and assess the reasonableness of model inputs, model structure, model outputs and conclusions."

Results:
Over the next 30 years (2011 to 2041),asthma, COPD and lung cancer were estimated to cumulatively cost Ontario society over $96.7 billion, $310.7 billion and $33.5 billion dollars in direct health care costs and indirect costs, respectively (in cumulative 2011 present value terms).

Conclusions:
The results of this study provide an indication of this burden and demonstrate how lung disease interventions could potentially reduce this burden. Given that smoking is a primary risk factor for many lung diseases, smoking prevalence coupled with the aging population demographics are expected to contribute to the significant rise in the burden of lung disease in Ontario. The current analysis estimated that by 2041 prevalence of asthma is expected to increase by 49%, COPD is expected to increase by 53% and lung cancer is expected to increase by 92%. Within the next 30 years over 2.5 million, 1.2 million and 63,000 people in Ontario are expected to be living with asthma, COPD and lung cancer, respectively. In the next 30 years this translates to approximately 20.5% of the total population in Ontario living with some form of lung disease. This increase may also place a significant burden on the capacity of the public and private health care systems to provide essential health care services.