Letter

29 December 2025 No. 1/1225-361

Dear Ministers, On behalf of the Baltic Assembly, we would like to express our sincere appreciation to the Ministers of Finance for fostering cooperation of the Baltic States within your respective areas of responsibility, thereby strengthening sound budget governance, fiscal coordination, and the long-term economic resilience of our region. On 12 December 2025, the conference of the Baltic Assembly “Health as an Investment in Baltic Security and Future” was held in Riga. During the conference, Baltic parliamentarians, representatives of respective ministries and experts discussed health being a powerful long-term investment. The Baltic States currently treat healthcare predominantly as an expense rather than a strategic investment. We believe that shifting this paradigm can unlock economic growth, enhance productivity, and ensure long-term prosperity for the region. Unfortunately, the Baltic health systems lag behind the averages of the European Union (EU). Compared with the EU, the Baltic States collectively spend 7.4 % of GDP on health care, which is substantially lower than the EU average of 10.0 %. This represents health spending that is about 26% lower than the EU benchmark. As a result, compared with the EU average, the Baltic population experiences shorter and less healthy lives. Life expectancy in the Baltics is 76.9 years, while the EU average is 81.5 years. Baltic citizens also have approximately 5.9 fewer healthy years at birth than the EU average. Poor health outcomes in the Baltic States are linked to high economic costs from reduced productivity, early mortality, absenteeism, and presenteeism - annually, GDP losses across all diseases amount to 9.7 billion euros in the Baltic States, equal to 6.4 % of total Baltic GDP. These findings are of serious concern and underscore the importance of the active and close involvement of the Ministers of Finance in this process. While representatives of the Ministries of Finance of the Baltic States were not able to participate in the conference, we would nevertheless highly value your perspectives on several key issues raised during the discussions:

 How do the Ministries of Finance currently assess health expenditure in the context of long-term economic growth?

 What tools or methodologies do the Ministries of Finance use or plan to develop to evaluate the return on investment of health initiatives across sectors, including productivity and labour market participation?

 Given the presented data on productivity losses, how can Ministries of Finance better collaborate with health authorities to quantify economic gains from improved population health?

Mr Arvils Ašeradens Minister for Finance

of the Republic of Latvia

Mr Jürgen Ligi Minister of Finance

of the Republic of Estonia

Mr Kristupas Vaitiekūnas Minister of Finance

of the Republic of Lithuania

 How do you envision stronger cooperation between the Ministries of Health and the Ministries of Finance, and other economic ministries to align health expenditure with economic and social policy goals?

 What steps can be taken to integrate health outcomes and return-on-investment metrics into multi-year fiscal planning and budget governance frameworks?

 Do you foresee adjustments to national budget priorities to support preventive health measures that demonstrate high economic return-on-investment?

 Would the Ministries of Finance support the development of a standardised regional framework for health return-on-investment measurement to enhance comparability and policy decision-making across the Baltic States?

We would greatly appreciate your replies by 2 March 2026 to ensure that the Health, Welfare and Family Committee of the Baltic Assembly can discuss the received answers at the meeting on 26-27 March 2026. Please find attached the presentation of the WifOR Institute.

Sincerely,

President of the Baltic Assembly

Vice President of the Baltic Assembly

Vice President of

the Baltic Assembly

Jānis Vucāns Republic of Latvia

Timo Suslov Republic of Estonia

Giedrius Drukteinis Republic of Lithuania

Chair of the Health, Welfare and Family

Committee of the Baltic Assembly

Vice Chair of the Health,

Welfare and Family Committee of

the Baltic Assembly

Vice Chair of the Health,

Welfare and Family Committee of

the Baltic Assembly

Antoņina Ņenaševa Republic of Latvia

Irja Lutsar Republic of Estonia

Saulius Čaplinskas Republic of Lithuania

Contact person: Agnija Antanovica, e-mail: [email protected]

29 December 2025 No. 1/1225-361

Dear Ministers, On behalf of the Baltic Assembly, we would like to express our sincere appreciation to the Ministers of Finance for fostering cooperation of the Baltic States within your respective areas of responsibility, thereby strengthening sound budget governance, fiscal coordination, and the long-term economic resilience of our region. On 12 December 2025, the conference of the Baltic Assembly “Health as an Investment in Baltic Security and Future” was held in Riga. During the conference, Baltic parliamentarians, representatives of respective ministries and experts discussed health being a powerful long-term investment. The Baltic States currently treat healthcare predominantly as an expense rather than a strategic investment. We believe that shifting this paradigm can unlock economic growth, enhance productivity, and ensure long-term prosperity for the region. Unfortunately, the Baltic health systems lag behind the averages of the European Union (EU). Compared with the EU, the Baltic States collectively spend 7.4 % of GDP on health care, which is substantially lower than the EU average of 10.0 %. This represents health spending that is about 26% lower than the EU benchmark. As a result, compared with the EU average, the Baltic population experiences shorter and less healthy lives. Life expectancy in the Baltics is 76.9 years, while the EU average is 81.5 years. Baltic citizens also have approximately 5.9 fewer healthy years at birth than the EU average. Poor health outcomes in the Baltic States are linked to high economic costs from reduced productivity, early mortality, absenteeism, and presenteeism - annually, GDP losses across all diseases amount to 9.7 billion euros in the Baltic States, equal to 6.4 % of total Baltic GDP. These findings are of serious concern and underscore the importance of the active and close involvement of the Ministers of Finance in this process. While representatives of the Ministries of Finance of the Baltic States were not able to participate in the conference, we would nevertheless highly value your perspectives on several key issues raised during the discussions:

 How do the Ministries of Finance currently assess health expenditure in the context of long-term economic growth?

 What tools or methodologies do the Ministries of Finance use or plan to develop to evaluate the return on investment of health initiatives across sectors, including productivity and labour market participation?

 Given the presented data on productivity losses, how can Ministries of Finance better collaborate with health authorities to quantify economic gains from improved population health?

Mr Arvils Ašeradens Minister for Finance

of the Republic of Latvia

Mr Jürgen Ligi Minister of Finance

of the Republic of Estonia

Mr Kristupas Vaitiekūnas Minister of Finance

of the Republic of Lithuania

 How do you envision stronger cooperation between the Ministries of Health and the Ministries of Finance, and other economic ministries to align health expenditure with economic and social policy goals?

 What steps can be taken to integrate health outcomes and return-on-investment metrics into multi-year fiscal planning and budget governance frameworks?

 Do you foresee adjustments to national budget priorities to support preventive health measures that demonstrate high economic return-on-investment?

 Would the Ministries of Finance support the development of a standardised regional framework for health return-on-investment measurement to enhance comparability and policy decision-making across the Baltic States?

We would greatly appreciate your replies by 2 March 2026 to ensure that the Health, Welfare and Family Committee of the Baltic Assembly can discuss the received answers at the meeting on 26-27 March 2026. Please find attached the presentation of the WifOR Institute.

Sincerely,

President of the Baltic Assembly

Vice President of the Baltic Assembly

Vice President of

the Baltic Assembly

Jānis Vucāns Republic of Latvia

Timo Suslov Republic of Estonia

Giedrius Drukteinis Republic of Lithuania

Chair of the Health, Welfare and Family

Committee of the Baltic Assembly

Vice Chair of the Health,

Welfare and Family Committee of

the Baltic Assembly

Vice Chair of the Health,

Welfare and Family Committee of

the Baltic Assembly

Antoņina Ņenaševa Republic of Latvia

Irja Lutsar Republic of Estonia

Saulius Čaplinskas Republic of Lithuania

Contact person: Agnija Antanovica, e-mail: [email protected]

Dr. Malina Müller December 12, 2025

If you measure it, you can shape it!

The Societal Value of Health: Investing in Innovation for Baltic Prosperity

Baltic Assembly Conference: Health as an investment in Baltic security and future

About WifOR

Worldwide presence Facts & Figures

Locations: Berlin, Darmstadt, Leipzig, Athens

Economic research institute ​

Spin-off from the Department of Public Economics & Economic

Policy at the Technical University of Darmstadt, Germany

80 Employees​

Over 650 successful projects for companies,

associations, and ministries​

Research areas:​

Projects in 55 countries – global, regional, and national analyses

HealthLabor Market Sustainability

Agenda

ROI and Societal Impact4

The Socioeconomic Burden – Method and selected Use Cases3

The Baltic Health & Economic Reality2

Paradigm Shift: Health as an Investment1

Recommendations5

1

Paradigm Shift: Health as an

Investment

5

WifOR is fostering a paradigm shift in health – from a cost factor to a

driver for growth, innovation, wealth, and prosperity with better health

Source: WifOR illustration, following Henke, Neumann, Schneider et al. (2010).

FUTUREPAST

Health Economy as a driver

for growth and employment

Growth sector,

increasing work force,

new career

opportunities

Investment in

health to promote

growth and productivity

Health Economy as a

diverse sector,

contribution to GDP

and employment

Better quality, more

outcome oriented

Healthcare as a

cost factor Separate silos and fragmentation |

Healthcare only | Input orientation |

Increasing health expenditures

€

If you measure it, you can shape it!

6

WifOR co-launched the G20 & G7 toolkit for strategic health investments

at the H20 Summit in Geneva Büroklammer

Source: WifOR 2025. Own illustration.

7

WifOR advocates the integration of global health metrics into policy

making at UN, WHO, G20, G7, EU Parliament, APEC, and others

Measure the social burden

(cost of illness)

Calculate the Social Impact

of medical interventions

Quantify economic impact

of investments

1 2 3

Source: WifOR illustration.

What is the return on investment (ROI) of health?

If you measure it, you can shape it!

2

The Baltic Health & Economic

Reality- Burden vs. EU

Benchmarks

9

Why shifting the paradigm from “cost” to “investment” is essential?

Source: Eurostat, 2023

Baltics Health Spending

• 7.4 % of GDP vs. EU 10.0 %

• 26 % lower than the EU average

(per capita ≈ €2,500 vs. EU €3,835)

Baltics Life Expectancy

• 76.9 years vs. EU 81.5 years

• 4.6 years shorter lives on average

If you measure it, you can shape it!

10

Annual GDP losses in the Baltics from health-related productivity losses

Source: derived estimates using Eurostat,2023. *Note: Totals may not sum due to rounding, €9.7 billion = total health-related productivity losses from all diseases and external causes combined (absenteeism, presenteeism and preventable deaths). The

preventable-deaths component (€5.9 bn) is calculated using the official Eurostat preventable-mortality categories mainly cardiovascular (55–60%), cancers (15–18%), mental/neurological (8–10%), and others (Eurostat preventable mortality distribution).**assuming

€200–300M per facility. ***average disposable household income ≈ €12,600 €.

.

Annual GDP losses

across all diseases

€9.7 billion per year*

= 6.4 % of total Baltic GDP

Absenteeism €1.52 billion

Presenteeism €2.28 billion

Preventable deaths €5.92 billion

Healthcare System Scale

• Enough to fund full universal healthcare for 3.6 million Baltic

citizens for one entire year.

Infrastructure Investment

• Enough to build and fully equip 30-45 state-of-the-art hospitals or

NCD centers across the three countries.**

Household Support

• Equals the total yearly income of more than 770,000 Baltic

families.***

4785

2738

2205

9728

6,40%

6,90%

5,70%

6,40%

0 2000 4000 6000 8000 10000 12000

Lithuania

Latvia

Estonia

Baltic Total

Annual GDP Losses from Health-Related Productivity Issues - Baltic States 2023

% GDP Total Loss (million €)

(all values in million €)

If you measure it, you can shape it!

11

Healthy life years (HLY) gap in the Baltics is 2-10 years below EU average

Source: Eurostat, 2023

Baltic citizens lose 6 healthy years

compared to the EU average

5.9 fewer healthy years at birth

(52.7- 60.9 vs. EU 63.1 years)

2.9 fewer healthy years at age 65

(4.8 - 7.6 vs. EU 9.5 years)

• €2 billion annual loss in productivity &

extra pension/long term care costs

(= 1.3 % of Baltic GDP)

Just 2 healthy years

of the gap

+ €1 billion economic

gain every year

If you measure it, you can shape it!

3

The Socioeconomic Burden –

Method and selected Use Cases

13

Individuals contribute to a nation’s wealth through both paid work and

unpaid work activities over their course of their lives

GDP: Gross Domestic Product.

Paid work

Unpaid work

activities

. . 20 . . . . . . . 30 . . . . . . . 40 . . . . . . . 50 . . . . . . 60 . . . 70 . . . . . . . 80 . . . . . 90 .

Retirement No gross value added in terms of

national accounts

Household production & voluntary work Additional (direct) value added ‘beyond’ GDP

Employment Direct, indirect and induced gross value added

Age

. . 20 . . . . . . . 30 . . . . . . . 40 . . . . . . . 50 . . . . . . 60 . . . . 70 . . . . . . . 80 . . . . . 90 . Age

C a p

a b

il it

y C

a p

a b

il it

y

⮚ By capturing unpaid work productivity in addition to paid work productivity, the Socioeconomic Burden of

Diseases includes the value lost beyond GDP from both employees and the non-working population.

If you measure it, you can shape it!

14

A disease not only affects patients’ paid and unpaid work productivity,

but impacts adjacent sectors and the broader economy

Sources: The effects of having a healthier population on the overall economy have been explored under the input-output (IO) model perspective (Leontief, 1986; Conway, 2022). Conway, R.S. (2022) Empirical Regional Economics.

Springer Texts in Business and Economics. Switzerland: Springer, p. 275. Available at: https://econpapers.repec.org/bookchap/sprsptbec/978-3-030-76646-7.htm (Accessed: 20 December 2022). Leontief, W. (1986) Input-Output

Economics. New York: Oxford University Press

GVA: Gross Value Added.

BROADER

ECONOMY

Unpaid Work

Direct Effects

Paid Work

Indirect Effects

Paid Work

Direct Effects

Paid Work

Induced Effects

The intermediate

consumption of

goods and services

from suppliers

triggered by the

direct GVA not

generated by paid

work due to

sickness.

PATIENT

The impact of

spending by

households not

receiving income

based on direct

and indirect

generated GVA.

Socioeconomic

Burden

The sum of Unpaid

Work Direct Effects

and Paid Work

Direct, Indirect and

Induced GVA

Effects.

Contributions from

unpaid work, such

as household

activities, vital to

the economy but

not reflected in the

GDP.

The immediate

economic impact

resulting from paid

work generated by

people becoming

sick.

If you measure it, you can shape it!

15

Quantifying the socioeconomic burden (SOB) of a disease

1 DALY

=

1 year fully disabled

=

1 year without

productivity/ work

capability

< 20 years

Paid

Work

Unpaid Work

Activities

Unpaid Work Activities

SOB

Burden of

disease in

terms of

monetized

paid and

unpaid work

losses

DALYs of persons under 20 years of age are not

monetized

DALY: Disability-Adjusted Life Year.

20-59 years

≥ 60 years

If you measure it, you can shape it!

16

Beyond the diagnosis: Socioeconomic burden of retinal disease

(AMD/DME) in Baltics (2025)

*Data based on DALYs and labor market participation, 2025 projections. **$3,000–$5,100 per patient per year (drug + visits + monitoring). *** assuming ~ 4$ - 7$M per center for construction + initial operating costs).

In 2025, the

Socioeconomic Burden of retinal

diseases is approximately

$97 million*

$40 million

$57 million

Paid work

Unpaid work

Treatment coverage for Retinal Patients

▪ Equivalent to treating 19,000 – 32,000 Baltic AMD and DME patients

for 1 year.**

Infrastructure Investment

▪ Enough to build 14-24 specialized retinal centers across the three

countries.***

Blindness Prevention

▪ Enough to prevent severe vision loss or legal blindness in 4,000 –

8,000 Baltic citizens over the next 10 years, through timely diagnosis

and effective retinal treatment.

If you measure it, you can shape it!

17

Beyond the diagnosis: Socioeconomic burden of HER2+ breast cancer

(BC) in Baltics (2025)

*Data based on DALYs and labor market participation, 2025 projections.** $40k–$60k per patient-year. ***assuming $150 per scan.

In 2025, the

Socioeconomic Burden of HER2+

BC is approximately

$288 million*

$121 million

$167 million

Paid work

Unpaid work

Treatment coverage for BC Patients

▪ Equivalent to providing full high efficacy HER2-targeted therapy for

4,800 -7,200 Baltic HER2+ BC.**

Early Detection

▪ Enough to fund 1.5 -1.9 million mammograms across the three

countries.***

Progression Prevention

▪ Enough to reduce the number of patients progressing to metastatic

HER2+ breast cancer by an estimated 800–1,600 cases over the next

10 years, through timely diagnosis and full access to high-efficacy

targeted therapy.

If you measure it, you can shape it!

18

The high socioeconomic burden of cardiovascular diseases (CVDs)

indicates that reducing the burden is essential

*Estimate based on results from Luengo-Fernandez et al. (2023) on the economic burden of CVD in the EU (2024), adapted using WifOR’s methodology. While Luengo-Fernandez et al. (2023) calculate direct costs (health, social, informal care) and productivity losses (valued with average

earnings), our approach builds on DALYs to capture the full potential productivity loss in terms of paid and unpaid work, valued via GVA, and includes indirect and induced economic effects. This adaptation results in an estimated GDP impact of 4–5%, compared to 2% in the original study.

**Estimations consider the forecasting of the country's economic development during the first 15 years after starting the P-CVD program. Source: WifOR Elaboration. HernandezVillafuerte,et al.. 2025.The Health ROI Assessor: Evaluating Novel CVD Prevention Approaches in Estonia. Value &

Outcomes Spotlight March/April 2025, pp 31-34

In Europe, CVDs is estimated to generate a social burden equivalent to

4-5 % of GDP*.

A €20 million prevention program in Estonia alone creates €127 million in societal

value over 15 years

= 7.75× return and 315 lives saved**.

In the Baltic States this equals €6 – 8 billion annually. If we prevented just

half of all CVD events → we would increase Baltic wealth by 2 – 2.5 % of

GDP

If you measure it, you can shape it!

4

ROI and Societal Impact

20

WifOR‘s Health ROI Assessor Framework

Additional details in Hernandez-Villafuerte, 2025

The Social Impact of

Health

If you measure it, you can shape it!

21

Macroeconomic value of a Cardiovascular Disease Prevention Program

in Estonia. Short term – Base case scenario

HE footprint

▪ An investment of €20 mio over five

years generates in terms of direct,

indirect, and induced effects

during the first 10 years:

▪ € 50 mio GVA value

▪ 1,178 additional workers.

Figure 5. Cumulative GVA Value Created via the HE Footprint

Source: WifOR Elaboration. Hernandez-Villafuerte et al.. 2025.The Health ROI Assessor:

Evaluating Novel CVD Prevention Approaches in Estonia. Value & Outcomes Spotlight

March/April 2025, pp 31-34

If you measure it, you can shape it!

22

Macroeconomic value of a Cardiovascular Disease Prevention Program

in Estonia. Short term – Base case scenario

The Social Impact of Health

▪ By avoiding 315 deaths and 928 non-fatal events, the program generates € 127.04 mio of value in

terms of increasing paid (€ 60.1 mio) and unpaid (€ 66.9 mio) work productivity during the first 15 years.

A. Unpaid Work B. Paid Work

Figure 6. Cumulative Gained Productivity – Short Term

Estimations consider the forecasting of the country's economic development during the first 15 years after starting the P-CVD program. Source: WifOR Elaboration. Hernandez-

Villafuerte,et al.. 2025.The Health ROI Assessor: Evaluating Novel CVD Prevention Approaches in Estonia. Value & Outcomes Spotlight March/April 2025, pp 31-34

If you measure it, you can shape it!

23

Health investments create a positive feedback loop

Source: own illustration. Sustainable Development Goals (UN).

Ensure healthy lives and

promote well-being for

all at all ages

SDG GOAL 3

Promote sustained,

inclusive and sustainable

economic growth, full and

productive employment

and decent work for all

SDG GOAL 8

More

Innovation

Better

Health Greater

Wealth

Build resilient infrastructure, promote sustainable

industrialization and foster innovation

SDG GOAL 9

If you measure it, you can shape it!

24

Investments in health pay off economically – in addition to health benefits,

they secure jobs and generate additional value added

Source: Federal Ministry for Economic Affairs and Energy (BMWE) (2022): Healthcare Industry – Facts & Figures. Results of the Healthcare Industry Accounts, data for 2022.

HEALTH & WELL-BEING

▪ Investments such as

vaccinations, screening, and

innovative treatments prevent

illness and death.

▪ They improve quality of life

and prolong life expectancy...

LABOR MARKET & SOCIETY

▪ ...but illness is holding back economic

potential.

▪ Investing in health secures existing

jobs and creates new ones.

▪ It prevents productivity losses and

recovers millions of working hours.

ECONOMY & PRODUCTIVITY

▪ Every euro invested generates

additional added value.

▪ Investments in health act as an

economic stimulus program with a

measurable return on investment

(ROI).

If you measure it, you can shape it!

5

Recommendations

26

How can we turn lost billions into saved lives?

Strengthen Baltic data exchange & EHDS

readiness

Increase prevention investments with

guaranteed ROI (retinal disease, CVD & BC)

Accelerate innovation access (WAIT

improvement target)

Introduce long-term ROI-based

budgeting

Implement a national

“Societal Value Mandate”

DATA 5

PREVENTION 4

SPEED 3

Horizon 2

VALUE 1

If you measure it, you can shape it!

www.wifor.com

WifOR

+49 30 2325 6665-0

+49 30 2325 6665-95

+49 1511 0580843

[email protected]

Institute

Joseph-Haydn-Strasse 1

10557 Berlin

Germany | Greece | Latin America | USA

Dr. Malina Müller

Head of Health Economics

28

Macroeconomic value of a Cardiovascular Disease Prevention Program

in Estonia. Long term – Scenario Analysis

▪ The Social Impact of Health

▪ Age 30 to 39 cohort lifetime

horizon

▪ By enrolling in the PCVD

program a cohort of 12,077

individuals between 30 and 39

years old

▪ 28.708 mio productive hours

are gained in paid and unpaid

activities

▪ Translated into €1,059.65 mio of

value creation.

Figure 7. Cumulative Gained Productivity in Paid and Unpaid

Work Activities: 30_39 Cohort (2015 prices).

Estimations assumes that the economic variables are constant after the first 15 years.

Source: WifOR Elaboration. Hernandez-Villafuerte et al.. 2025.The Health ROI Assessor: Evaluating

Novel CVD Prevention Approaches in Estonia. Value & Outcomes Spotlight March/April 2025, pp 31-34

If you measure it, you can shape it!

Dr. Malina Müller December 12, 2025

If you measure it, you can shape it!

The Societal Value of Health: Investing in Innovation for Baltic Prosperity

Baltic Assembly Conference: Health as an investment in Baltic security and future

About WifOR

Worldwide presence Facts & Figures

Locations: Berlin, Darmstadt, Leipzig, Athens

Economic research institute ​

Spin-off from the Department of Public Economics & Economic

Policy at the Technical University of Darmstadt, Germany

80 Employees​

Over 650 successful projects for companies,

associations, and ministries​

Research areas:​

Projects in 55 countries – global, regional, and national analyses

HealthLabor Market Sustainability

Agenda

ROI and Societal Impact4

The Socioeconomic Burden – Method and selected Use Cases3

The Baltic Health & Economic Reality2

Paradigm Shift: Health as an Investment1

Recommendations5

1

Paradigm Shift: Health as an

Investment

5

WifOR is fostering a paradigm shift in health – from a cost factor to a

driver for growth, innovation, wealth, and prosperity with better health

Source: WifOR illustration, following Henke, Neumann, Schneider et al. (2010).

FUTUREPAST

Health Economy as a driver

for growth and employment

Growth sector,

increasing work force,

new career

opportunities

Investment in

health to promote

growth and productivity

Health Economy as a

diverse sector,

contribution to GDP

and employment

Better quality, more

outcome oriented

Healthcare as a

cost factor Separate silos and fragmentation |

Healthcare only | Input orientation |

Increasing health expenditures

€

If you measure it, you can shape it!

6

WifOR co-launched the G20 & G7 toolkit for strategic health investments

at the H20 Summit in Geneva Büroklammer

Source: WifOR 2025. Own illustration.

7

WifOR advocates the integration of global health metrics into policy

making at UN, WHO, G20, G7, EU Parliament, APEC, and others

Measure the social burden

(cost of illness)

Calculate the Social Impact

of medical interventions

Quantify economic impact

of investments

1 2 3

Source: WifOR illustration.

What is the return on investment (ROI) of health?

If you measure it, you can shape it!

2

The Baltic Health & Economic

Reality- Burden vs. EU

Benchmarks

9

Why shifting the paradigm from “cost” to “investment” is essential?

Source: Eurostat, 2023

Baltics Health Spending

• 7.4 % of GDP vs. EU 10.0 %

• 26 % lower than the EU average

(per capita ≈ €2,500 vs. EU €3,835)

Baltics Life Expectancy

• 76.9 years vs. EU 81.5 years

• 4.6 years shorter lives on average

If you measure it, you can shape it!

10

Annual GDP losses in the Baltics from health-related productivity losses

Source: derived estimates using Eurostat,2023. *Note: Totals may not sum due to rounding, €9.7 billion = total health-related productivity losses from all diseases and external causes combined (absenteeism, presenteeism and preventable deaths). The

preventable-deaths component (€5.9 bn) is calculated using the official Eurostat preventable-mortality categories mainly cardiovascular (55–60%), cancers (15–18%), mental/neurological (8–10%), and others (Eurostat preventable mortality distribution).**assuming

€200–300M per facility. ***average disposable household income ≈ €12,600 €.

.

Annual GDP losses

across all diseases

€9.7 billion per year*

= 6.4 % of total Baltic GDP

Absenteeism €1.52 billion

Presenteeism €2.28 billion

Preventable deaths €5.92 billion

Healthcare System Scale

• Enough to fund full universal healthcare for 3.6 million Baltic

citizens for one entire year.

Infrastructure Investment

• Enough to build and fully equip 30-45 state-of-the-art hospitals or

NCD centers across the three countries.**

Household Support

• Equals the total yearly income of more than 770,000 Baltic

families.***

4785

2738

2205

9728

6,40%

6,90%

5,70%

6,40%

0 2000 4000 6000 8000 10000 12000

Lithuania

Latvia

Estonia

Baltic Total

Annual GDP Losses from Health-Related Productivity Issues - Baltic States 2023

% GDP Total Loss (million €)

(all values in million €)

If you measure it, you can shape it!

11

Healthy life years (HLY) gap in the Baltics is 2-10 years below EU average

Source: Eurostat, 2023

Baltic citizens lose 6 healthy years

compared to the EU average

5.9 fewer healthy years at birth

(52.7- 60.9 vs. EU 63.1 years)

2.9 fewer healthy years at age 65

(4.8 - 7.6 vs. EU 9.5 years)

• €2 billion annual loss in productivity &

extra pension/long term care costs

(= 1.3 % of Baltic GDP)

Just 2 healthy years

of the gap

+ €1 billion economic

gain every year

If you measure it, you can shape it!

3

The Socioeconomic Burden –

Method and selected Use Cases

13

Individuals contribute to a nation’s wealth through both paid work and

unpaid work activities over their course of their lives

GDP: Gross Domestic Product.

Paid work

Unpaid work

activities

. . 20 . . . . . . . 30 . . . . . . . 40 . . . . . . . 50 . . . . . . 60 . . . 70 . . . . . . . 80 . . . . . 90 .

Retirement No gross value added in terms of

national accounts

Household production & voluntary work Additional (direct) value added ‘beyond’ GDP

Employment Direct, indirect and induced gross value added

Age

. . 20 . . . . . . . 30 . . . . . . . 40 . . . . . . . 50 . . . . . . 60 . . . . 70 . . . . . . . 80 . . . . . 90 . Age

C a p

a b

il it

y C

a p

a b

il it

y

⮚ By capturing unpaid work productivity in addition to paid work productivity, the Socioeconomic Burden of

Diseases includes the value lost beyond GDP from both employees and the non-working population.

If you measure it, you can shape it!

14

A disease not only affects patients’ paid and unpaid work productivity,

but impacts adjacent sectors and the broader economy

Sources: The effects of having a healthier population on the overall economy have been explored under the input-output (IO) model perspective (Leontief, 1986; Conway, 2022). Conway, R.S. (2022) Empirical Regional Economics.

Springer Texts in Business and Economics. Switzerland: Springer, p. 275. Available at: https://econpapers.repec.org/bookchap/sprsptbec/978-3-030-76646-7.htm (Accessed: 20 December 2022). Leontief, W. (1986) Input-Output

Economics. New York: Oxford University Press

GVA: Gross Value Added.

BROADER

ECONOMY

Unpaid Work

Direct Effects

Paid Work

Indirect Effects

Paid Work

Direct Effects

Paid Work

Induced Effects

The intermediate

consumption of

goods and services

from suppliers

triggered by the

direct GVA not

generated by paid

work due to

sickness.

PATIENT

The impact of

spending by

households not

receiving income

based on direct

and indirect

generated GVA.

Socioeconomic

Burden

The sum of Unpaid

Work Direct Effects

and Paid Work

Direct, Indirect and

Induced GVA

Effects.

Contributions from

unpaid work, such

as household

activities, vital to

the economy but

not reflected in the

GDP.

The immediate

economic impact

resulting from paid

work generated by

people becoming

sick.

If you measure it, you can shape it!

15

Quantifying the socioeconomic burden (SOB) of a disease

1 DALY

=

1 year fully disabled

=

1 year without

productivity/ work

capability

< 20 years

Paid

Work

Unpaid Work

Activities

Unpaid Work Activities

SOB

Burden of

disease in

terms of

monetized

paid and

unpaid work

losses

DALYs of persons under 20 years of age are not

monetized

DALY: Disability-Adjusted Life Year.

20-59 years

≥ 60 years

If you measure it, you can shape it!

16

Beyond the diagnosis: Socioeconomic burden of retinal disease

(AMD/DME) in Baltics (2025)

*Data based on DALYs and labor market participation, 2025 projections. **$3,000–$5,100 per patient per year (drug + visits + monitoring). *** assuming ~ 4$ - 7$M per center for construction + initial operating costs).

In 2025, the

Socioeconomic Burden of retinal

diseases is approximately

$97 million*

$40 million

$57 million

Paid work

Unpaid work

Treatment coverage for Retinal Patients

▪ Equivalent to treating 19,000 – 32,000 Baltic AMD and DME patients

for 1 year.**

Infrastructure Investment

▪ Enough to build 14-24 specialized retinal centers across the three

countries.***

Blindness Prevention

▪ Enough to prevent severe vision loss or legal blindness in 4,000 –

8,000 Baltic citizens over the next 10 years, through timely diagnosis

and effective retinal treatment.

If you measure it, you can shape it!

17

Beyond the diagnosis: Socioeconomic burden of HER2+ breast cancer

(BC) in Baltics (2025)

*Data based on DALYs and labor market participation, 2025 projections.** $40k–$60k per patient-year. ***assuming $150 per scan.

In 2025, the

Socioeconomic Burden of HER2+

BC is approximately

$288 million*

$121 million

$167 million

Paid work

Unpaid work

Treatment coverage for BC Patients

▪ Equivalent to providing full high efficacy HER2-targeted therapy for

4,800 -7,200 Baltic HER2+ BC.**

Early Detection

▪ Enough to fund 1.5 -1.9 million mammograms across the three

countries.***

Progression Prevention

▪ Enough to reduce the number of patients progressing to metastatic

HER2+ breast cancer by an estimated 800–1,600 cases over the next

10 years, through timely diagnosis and full access to high-efficacy

targeted therapy.

If you measure it, you can shape it!

18

The high socioeconomic burden of cardiovascular diseases (CVDs)

indicates that reducing the burden is essential

*Estimate based on results from Luengo-Fernandez et al. (2023) on the economic burden of CVD in the EU (2024), adapted using WifOR’s methodology. While Luengo-Fernandez et al. (2023) calculate direct costs (health, social, informal care) and productivity losses (valued with average

earnings), our approach builds on DALYs to capture the full potential productivity loss in terms of paid and unpaid work, valued via GVA, and includes indirect and induced economic effects. This adaptation results in an estimated GDP impact of 4–5%, compared to 2% in the original study.

**Estimations consider the forecasting of the country's economic development during the first 15 years after starting the P-CVD program. Source: WifOR Elaboration. HernandezVillafuerte,et al.. 2025.The Health ROI Assessor: Evaluating Novel CVD Prevention Approaches in Estonia. Value &

Outcomes Spotlight March/April 2025, pp 31-34

In Europe, CVDs is estimated to generate a social burden equivalent to

4-5 % of GDP*.

A €20 million prevention program in Estonia alone creates €127 million in societal

value over 15 years

= 7.75× return and 315 lives saved**.

In the Baltic States this equals €6 – 8 billion annually. If we prevented just

half of all CVD events → we would increase Baltic wealth by 2 – 2.5 % of

GDP

If you measure it, you can shape it!

4

ROI and Societal Impact

20

WifOR‘s Health ROI Assessor Framework

Additional details in Hernandez-Villafuerte, 2025

The Social Impact of

Health

If you measure it, you can shape it!

21

Macroeconomic value of a Cardiovascular Disease Prevention Program

in Estonia. Short term – Base case scenario

HE footprint

▪ An investment of €20 mio over five

years generates in terms of direct,

indirect, and induced effects

during the first 10 years:

▪ € 50 mio GVA value

▪ 1,178 additional workers.

Figure 5. Cumulative GVA Value Created via the HE Footprint

Source: WifOR Elaboration. Hernandez-Villafuerte et al.. 2025.The Health ROI Assessor:

Evaluating Novel CVD Prevention Approaches in Estonia. Value & Outcomes Spotlight

March/April 2025, pp 31-34

If you measure it, you can shape it!

22

Macroeconomic value of a Cardiovascular Disease Prevention Program

in Estonia. Short term – Base case scenario

The Social Impact of Health

▪ By avoiding 315 deaths and 928 non-fatal events, the program generates € 127.04 mio of value in

terms of increasing paid (€ 60.1 mio) and unpaid (€ 66.9 mio) work productivity during the first 15 years.

A. Unpaid Work B. Paid Work

Figure 6. Cumulative Gained Productivity – Short Term

Estimations consider the forecasting of the country's economic development during the first 15 years after starting the P-CVD program. Source: WifOR Elaboration. Hernandez-

Villafuerte,et al.. 2025.The Health ROI Assessor: Evaluating Novel CVD Prevention Approaches in Estonia. Value & Outcomes Spotlight March/April 2025, pp 31-34

If you measure it, you can shape it!

23

Health investments create a positive feedback loop

Source: own illustration. Sustainable Development Goals (UN).

Ensure healthy lives and

promote well-being for

all at all ages

SDG GOAL 3

Promote sustained,

inclusive and sustainable

economic growth, full and

productive employment

and decent work for all

SDG GOAL 8

More

Innovation

Better

Health Greater

Wealth

Build resilient infrastructure, promote sustainable

industrialization and foster innovation

SDG GOAL 9

If you measure it, you can shape it!

24

Investments in health pay off economically – in addition to health benefits,

they secure jobs and generate additional value added

Source: Federal Ministry for Economic Affairs and Energy (BMWE) (2022): Healthcare Industry – Facts & Figures. Results of the Healthcare Industry Accounts, data for 2022.

HEALTH & WELL-BEING

▪ Investments such as

vaccinations, screening, and

innovative treatments prevent

illness and death.

▪ They improve quality of life

and prolong life expectancy...

LABOR MARKET & SOCIETY

▪ ...but illness is holding back economic

potential.

▪ Investing in health secures existing

jobs and creates new ones.

▪ It prevents productivity losses and

recovers millions of working hours.

ECONOMY & PRODUCTIVITY

▪ Every euro invested generates

additional added value.

▪ Investments in health act as an

economic stimulus program with a

measurable return on investment

(ROI).

If you measure it, you can shape it!

5

Recommendations

26

How can we turn lost billions into saved lives?

Strengthen Baltic data exchange & EHDS

readiness

Increase prevention investments with

guaranteed ROI (retinal disease, CVD & BC)

Accelerate innovation access (WAIT

improvement target)

Introduce long-term ROI-based

budgeting

Implement a national

“Societal Value Mandate”

DATA 5

PREVENTION 4

SPEED 3

Horizon 2

VALUE 1

If you measure it, you can shape it!

www.wifor.com

WifOR

+49 30 2325 6665-0

+49 30 2325 6665-95

+49 1511 0580843

[email protected]

Institute

Joseph-Haydn-Strasse 1

10557 Berlin

Germany | Greece | Latin America | USA

Dr. Malina Müller

Head of Health Economics

28

Macroeconomic value of a Cardiovascular Disease Prevention Program

in Estonia. Long term – Scenario Analysis

▪ The Social Impact of Health

▪ Age 30 to 39 cohort lifetime

horizon

▪ By enrolling in the PCVD

program a cohort of 12,077

individuals between 30 and 39

years old

▪ 28.708 mio productive hours

are gained in paid and unpaid

activities

▪ Translated into €1,059.65 mio of

value creation.

Figure 7. Cumulative Gained Productivity in Paid and Unpaid

Work Activities: 30_39 Cohort (2015 prices).

Estimations assumes that the economic variables are constant after the first 15 years.

Source: WifOR Elaboration. Hernandez-Villafuerte et al.. 2025.The Health ROI Assessor: Evaluating

Novel CVD Prevention Approaches in Estonia. Value & Outcomes Spotlight March/April 2025, pp 31-34

If you measure it, you can shape it!