European Journal of Epidemiology

, Volume 30, Issue 4, pp 251–277 | Cite as

The global impact of non-communicable diseases on healthcare spending and national income: a systematic review

  • Taulant Muka
  • David Imo
  • Loes Jaspers
  • Veronica Colpani
  • Layal Chaker
  • Sven J. van der Lee
  • Shanthi Mendis
  • Rajiv Chowdhury
  • Wichor M. Bramer
  • Abby Falla
  • Raha Pazoki
  • Oscar H. FrancoEmail author


The impact of non-communicable diseases (NCDs) in populations extends beyond ill-health and mortality with large financial consequences. To systematically review and meta-analyze studies evaluating the impact of NCDs (including coronary heart disease, stroke, type 2 diabetes mellitus, cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease and chronic kidney disease) at the macro-economic level: healthcare spending and national income. Medical databases (Medline, Embase and Google Scholar) up to November 6th 2014. For further identification of suitable studies, we searched reference lists of included studies and contacted experts in the field. We included randomized controlled trials, systematic reviews, cohorts, case–control, cross-sectional, modeling and ecological studies carried out in adults assessing the economic consequences of NCDs on healthcare spending and national income without language restrictions. All abstracts and full text selection was done by two independent reviewers. Any disagreements were resolved through consensus or consultation of a third reviewer. Data were extracted by two independent reviewers using a pre-designed data collection form. Studies evaluating the impact of at least one of the selected NCDs on at least one of the following outcome measures: healthcare expenditure, national income, hospital spending, gross domestic product (GDP), gross national product, net national income, adjusted national income, total costs, direct costs, indirect costs, inpatient costs, outpatient costs, per capita healthcare spending, aggregate economic outcome, capital loss in production levels in a country, economic growth, GDP per capita (per capita income), percentage change in GDP, intensive growth, extensive growth, employment, direct governmental expenditure and non-governmental expenditure. From 4,364 references, 153 studies met our inclusion criteria. Most of the studies were focused on healthcare related costs of NCDs. 30 studies reported the economic impact of NCDs on healthcare budgets and 13 on national income. Healthcare expenditure for cardiovascular disease (12–16.5 %) was the highest; other NCDs ranged between 0.7 and 7.4 %. NCD-related health costs vary across the countries, regions, and according to type of NCD. Additionally, there is an increase in costs with increased severity and years lived with the disease. Low- and middle-income (LMI) countries were the focus of just 16 papers, which suggests an information shortage concerning the true economic burden of NCDs in these countries. NCDs pose a significant financial burden on healthcare budgets and nations’ welfare, which is likely to increase over time. However further work is required to standardize more consistently the methods available to assess the economic impact of NCDs and to involve (hitherto under-addressed) LMI populations across the globe.


Non-communicable diseases National income Health expenditure Systematic review 



Completion of this manuscript was supported by a grant from the WHO. O.H. Franco, T. Muka and L. Jaspers work in ErasmusAGE, a center for aging research across the life course funded by Nestlé Nutrition (Nestec Ltd.); Metagenics Inc.; and AXA. Nestlé Nutrition (Nestec Ltd.); Metagenics Inc.; and AXA had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review or approval of the manuscript. Dr. Shanthi Mendis from the WHO and co-author on this manuscript participated in the interpretation and preparation of this manuscript. The manuscript was approved by the WHO for submission.

Supplementary material

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Supplementary material 1 (DOCX 63 kb)
10654_2014_9984_MOESM2_ESM.doc (96 kb)
Supplementary material 2 (DOC 95 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Taulant Muka
    • 1
  • David Imo
    • 1
  • Loes Jaspers
    • 1
  • Veronica Colpani
    • 1
  • Layal Chaker
    • 1
    • 2
  • Sven J. van der Lee
    • 1
  • Shanthi Mendis
    • 3
  • Rajiv Chowdhury
    • 4
  • Wichor M. Bramer
    • 5
  • Abby Falla
    • 6
    • 7
  • Raha Pazoki
    • 1
  • Oscar H. Franco
    • 1
    Email author
  1. 1.Department of EpidemiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
  2. 2.Department of EndocrinologyErasmus MCRotterdamThe Netherlands
  3. 3.Chronic Diseases Prevention and Management, Department of Chronic Diseases and Health PromotionWorld Health OrganizationGenevaSwitzerland
  4. 4.Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
  5. 5.Medical LibraryErasmus MCRotterdamThe Netherlands
  6. 6.Department of Public HealthErasmus MCRotterdamThe Netherlands
  7. 7.Division of Infectious Disease ControlMunicipal Public Health Service (GGD) Rotterdam-RijnmondRotterdamThe Netherlands

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