In Slovakia, the first model that measures the fiscal impacts of a specific disease on public finances was introduced. The pilot was multiple myeloma, and the results show how the disease affects taxes, contributions, social benefits, and caregiving costs. The model complements traditional drug assessment with the state’s perspective on revenues and expenditures associated with patients.
How the model works
The model balances what the state gains from taxes and contributions and what it must spend on benefits and services associated with the disease. It incorporates data on incidence and mortality, years of life lost and productive life lost, costs of sick leave and disability pensions, as well as the impact of care provided by relatives. It compares the diseased population with the general population and also uses macro indicators, such as GDP per worker and the tax-to-GDP ratio. Data were provided mainly by Sociálna poisťovňa and NCZI; international indicators are from publicly available sources.
What the pilot on multiple myeloma showed
The analysis covered the years 2009–2023 in the area of blood cancers; for multiple myeloma there were 307 patients in 2009 and 333 in 2023. Net fiscal impacts for Slovakia increased from 3,2 mil. € in 2009 to 6,2 mil. € in 2023, i.e., by approximately 91 %. After accounting for differences relative to the healthy population, the model shows an overall fiscal burden trending from about 20 mil. € to 32 mil. € by 2030. Per patient, that comes to 65 000 € in 2009 and 96 727 € in 2023; net of healthcare expenditures, it is approximately 10 600–18 700 € in 2023.
Return-to-work scenarios suggest significant room for savings. If the time to return could be shortened by 10 %, the state would save about 460 000 € per year according to the model; at 30 %, it would amount to roughly 2 mil. € per year. This represents a real return on investments in measures that shorten sick leave and support patient employment. The calculations are based on the same data foundation and methodology as the rest of the model.
