Validating a method to assess disease burden from insurance claims

Area of Science:

• Health Economics
• Public Health
• Epidemiology

Background:

• Estimating disease burden is crucial for resource allocation in healthcare.
• Traditional methods may not fully capture the impact on insured populations.
• Disability-Adjusted Life-Years (DALYs) offer a comprehensive measure of disease impact.

Purpose of the Study:

• To validate a method for estimating disease burden using DALYs.
• To utilize insurance claims and death records for burden estimation.
• To identify conditions with the greatest disease burden in an insured population.

Main Methods:

• Compared DALYs from claims/death records with self-reported health status.
• Included individuals with commercial insurance products who completed health assessments.
• Employed Spearman's rank-order correlation (ρ) to assess relationships.

Main Results:

• DALYs showed significant negative correlations with self-reported function (ρ ≈ -0.23) and health (ρ ≈ -0.19).
• These correlations were comparable in magnitude to those for the number of medical conditions per member.
• DALY correlations with function and health were stronger than correlations with claims cost.

Conclusions:

• DALYs calculated from insurance claims and death records are a valid tool.
• This method is cost-effective for identifying high-burden conditions.
• Health plans can use this approach to understand and address population health needs.