Over the last two decades, healthcare costs have become a major topic of conservation and a major worry for governments, businesses, healthcare providers and private citizens. Medicare and Medicaid capture nearly one-quarter of the U.S. federal budget, while according to Bloomberg, healthcare takes up more than 15% of consumer spending. Healthcare costs have likewise loomed large for many corporate pension plans and many companies have cut or stopped subsidizing health insurance costs for workers.

So, what are the biggest items on the national healthcare bill? While there are a lot of complicating factors in the math (as well as double-counting), it's fairly clear that heart disease, obesity, diabetes and cancer make some of the largest demands on the U.S. healthcare budget.

A Note on Math
Unfortunately, calculating the cost of various diseases is not a straightforward exercise. Not only are there issues of advocacy to consider (patient and research groups have an incentive to make their particular cause look more important), but the line between direct and indirect cost can be blurry at best. Likewise, double-counting is a major problem – obesity, hypertension, diabetes, and heart disease often overlap and co-present and it can be very difficult (if not impossible) to properly tease out which dollar should be allocated to which disease.

Heart Disease
It is not surprising that heart disease often features prominently on lists of expensive diseases. Estimates of the cost of heart disease range from around $100 billion to more than $440 billion, according to the Centers of Disease Control and Prevention. Unfortunately, this is an area rife with double-counting. "Core" coronary disease (atherosclerosis, high cholesterol, heart attack, bypass and so on) is believed to count for nearly $110 billion in annual costs, while hypertension (over $90 billion) and stroke ($54 billion) are often included as well. Drilling a little deeper, Forbes reports that congestive heart failure alone is thought to demand about $33 billion to $34 billion a year in annual U.S. healthcare expenditures.

Diabetes was once a relatively uncommon autoimmune disease (Type 1 diabetes), but has since become a major healthcare problem due to the spread of obesity-related Type 2 diabetes. Diabetes itself requires money to manage - in the form of oral medications, injected medications, insulin, glucose testing products and so on.

There are also costs tied to additional healthcare services (emergency visits for hypoglycemia, for instance), but the biggest issue with diabetes is that it significantly increases the likelihood of cardiovascular, kidney, vision and other health problems. Estimates of the direct cost of diabetes start at around $46 billion, while the American Diabetes Association projects total costs of $174 billion, with nearly $60 billion of that coming from the admittedly hard-to-prove "reduced national productivity."

Obesity highlights the somewhat fuzzy math that goes into projecting total systemic costs for specific diseases or conditions. Estimates for the cost of obesity often range from nearly $150 billion to almost $200 billion, with one source estimating $45 billion in in-patient costs and $69 billion in drug costs. Unfortunately, those numbers are a bit dubious. There are relatively few prescriptions written for weight loss drugs (though companies like Vivus and Arena hope to change this), and likewise there are relatively few procedures or hospitalizations specific for obesity. Instead, obesity is a known contributor to heart disease, cancer, joint damage and many other expensive-to-treat conditions. Likewise, the cost of over-the-counter spending on "diet" or "lite" products is hard to gauge, as well as spending on weight-loss supplements or products, or services like those provided by Weight Watchers and Jenny Craig.

As cancer doesn't really lead to other diseases or conditions, attributing the economic impact of cancer should be easier. While the American Cancer Society does estimate that the indirect costs of cancer exceed $120 billion, sources like ACS and the National Cancer Institute broadly agree on the direct costs of cancer - from around $100 billion to $125 billion a year. Breast cancer is the biggest consumer of economic resources at over $16 billion in direct costs, while colorectal, lung, lymphoma and prostate cancer all cost over $10 billion a year to treat.

Other Diseases and Conditions of Note
With the previously mentioned warnings about the dangers of double-counting, there are several other conditions and diseases that constitute sizable economic burdens to the U.S. healthcare system. Estimates of the cost of respiratory diseases like COPD and asthma run as high as $54 billion according to Web MD, with estimates for the direct cost of asthma (medications, hospitalization, etc.) running between $10 billion and $15 billion. Estimates for the cost of mental illness run from $48 billion to more than $100 billion, with Alzheimer's disease advocates frequently pointing to the high cost of nursing home and supportive care.

Arthritis is believed to cost the healthcare system at least $8 billion a year, while some sources estimate nearly $60 billion in total costs for "joint problems" that include chronic back issues (which alone are estimated to be over $35 billion a year). Last and certainly not least, though it doesn't often garner much discussion, the cost of treating sepsis (severe infection that can be caused by several bacteria) is estimated at over $15 billion a year.

The Bottom Line
Examining the most costly diseases in America brings home several key points. First, the U.S. spends a truly enormous amount of money on diseases that are in many cases avoidable with a commitment to healthier living. Second, there are numerous ways to calculate the cost of a disease, and that makes it a little easier to produce eye-popping numbers when the circumstances call for it.

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