Prevalences and healthcare expenditures related to 58 health conditions from 2012 to 2017 in France: diseases and healthcare expenditure mapping, a national population-based study

Rachas, A.; Gastaldi-Menager, C.; Denis, P.; Lesuffleur, T.; Nicolas, M.; Pestel, L.; Mette, C.; Drouin, J.; Riviere, S.; Tajahmady, A.; Gissot, C.; Fagot-Campagna, A.

Background Description of the prevalence of diseases and resources mobilized for the management of each disease is essential to identify public health priorities. We described the prevalences of 58 health conditions and all reimbursed healthcare expenditure by health condition in France between 2012 and 2017. Methods and Findings All national health insurance general scheme beneficiaries (87% of the French population) with at least one reimbursed healthcare expenditure were included from the French national health database. We identified health conditions (diseases, episodes of care, chronic treatments) by algorithms using ICD-10 codes for long-term diseases or hospitalisations, medications or medical procedures. We reported crude and age and sex-standardized annual prevalences between 2012 and 2017, and total and mean (per patient) reimbursed expenditure attributed to each condition without double counting, and according to the type of expenditure. In 2017, in a population of 57.6 million people (54% of women, median age: 40 years), the most prevalent diseases were diabetes (standardized prevalence: 5.8%), chronic respiratory diseases (5.5%) and chronic coronary heart disease (2.9%). Diseases concentrating the highest expenditures were active cancers (10% of total expenditure of 140.1 billion euros), mental illness (10%; neurotic and mood disorders: 4%; psychotic disorders: 3%), and chronic cardiovascular diseases (8%). Between 2012 and 2017, the most marked increase in total expenditure concerned liver and pancreatic diseases (+9.3%), related to the increased drug expenditure in 2014. Conversely, the increase in the number of patients (and the prevalence) explained the majority of the increase of total expenditures for cardiovascular disease, diabetes and mental illness. Conclusions These results showed a regular increase of the prevalence and expenditure of certain chronic diseases, probably related to ageing of the population, and increased expenditures related to major therapeutic innovations. The Diseases and Healthcare Expenditure Mapping therefore enlightens decision-makers in charge of public health and health accounts.