Cost of disorders of the brain in Europe 2010

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Abstract

Background

The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people.

Aims

To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country.

Methods

The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27 + Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010.

Results

The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US.

Discussion

This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges.

Recommendations

Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.

Introduction

In 2005, the European Brain Council published the results of a comprehensive study estimating the cost of disorders of the brain in Europe in 2004 (Andlin-Sobocki et al., 2005, Wittchen and Jacobi, 2005), below called the EBC2005 study. The label “disorders of the brain” or in short “brain disorders” was chosen to acknowledge the communalities of mental and neurological disorders in terms of their substrate, the brain, as well as the increasingly broader evidence that both disciplines, despite different traditions, share many common methods and approaches. It should also be mentioned that various other terms that at least partly overlap exist, such as neuropsychiatric disorders, or MNS (mental, neurological and substance use disorders).

In the EBC2005 study, the total cost in Europe, including the EU member states, Iceland, Norway and Switzerland, was estimated at €386 billion in 2004, distributed over 12 diagnostic groups of important disorders of the brain affecting 127 million adult Europeans. The study was labeled a benchmark study because it was the first ever to attempt to combine the available epidemiologic and economic evidence of disorders of the brain in an effort to estimate their total cost within a common methodological framework. Moreover, it was instrumental in demonstrating the large societal cost associated with disorders of the brain and the importance of decisions on future strategies to alleviate their burden.

The EBC2005 report had an enormous impact on various levels. Numerous highly listed disorder-specific and country-specific reports further exploring the economic consequences of disorders of the brain were important spin-offs of this first report. The 2005 report was presented to the European Commission and to European parliamentarians and has undoubtedly played a role in increasing the focus and shaping the political agenda on brain research and brain diseases at a European and national level. As a consequence, the number of studies exploring different aspects of the cost of disorders of the brain has steadily increased over time. In 2005, about 400 studies including the key words “cost” and “brain” were published (THOMSON REUTERS (ISI) 2010 http://portal.isiknowledge.com/). Over the next four years, this figure almost doubled, partly spurred by new initiatives coming out of the EBC2005 study (Andlin-Sobocki et al., 2005) (Fig. 1).

Our 2005 report could not cover many important disorders and cost items, mainly due to lack of data. During the past five years, the evidence base has grown and there are now possibilities for including previously omitted diagnoses and cost items. The larger evidence base also enables better precision in some of the estimates of the previously reviewed disorders of the brain. Further, Bulgaria and Romania are now part of the European Union and therefore are included in the present study.

Since 2005, important steps have been taken to strengthen the research focusing on the disorders of the brain in Europe, most importantly the specific mention of mental health and brain research in the seventh framework program of research (FP7). However, there were also some more recent negative developments, such as the withdrawal of a number of major pharmaceutical companies from key areas of neuroscience research (Nutt and Goodwin, 2011) and the move of industrial research away from Europe. While new initiatives, such as the Innovative Medicines Initiative by the EU, may give new opportunities, it is increasingly important that relevant information on the cost of disorders of the brain becomes available to decision makers. The present update and extension of the EBC2005 study is an attempt to fill this gap. It will hopefully serve to inform policy makers about the need for continuous focus on disorders of the brain in the forthcoming eighth framework program of research (FP8).

The study was commissioned by the European Brain Council (EBC). It was designed and managed by a steering committee including professors Jes Olesen, Hans-Ulrich Wittchen and Bengt Jönsson in collaboration with lead health economists Anders Gustavsson and Mikael Svensson.

The review of epidemiological data was conducted by panels of European experts (one panel for each disorder). The panel members for each disorder are listed in Table 1.

A health economic expert panel was formed with the aim to validate the study design and assist in the interpretation of data. The panel was chaired by Prof Bengt Jönsson and included the following members: Dr. Gisela Kobelt, Dr. Linus Jönsson, Prof. Massimo Moscarelli and Prof. Martin Knapp.

The coordination of the study, review of the economic data, analysis of data and drafting of reports was conducted by the company OptumInsight, led by Anders Gustavsson. The employees at OptumInsight contributing to this study included Korinna Karampampa, Mattias Ekman, Amir Musayev, Brenda Gannon and Christina Ljungcrantz.

The objective of this study was to estimate:

  • 1.

    the number of persons with defined disorders of the brain in Europe in 2010

  • 2.

    the total cost per person related to each disease by specifying direct and indirect costs

  • 3.

    to estimate the total cost per disorder and country.

More generally, the aim was to provide a revised, improved, up-to-date estimate of the cost of disorders of the brain in all of Europe, incorporating relevant cost items, diagnoses and age groups that were not included in the EBC2005 study due to limitations in the available data.

Section snippets

Disorders of the brain

The methods and design of this study have already been presented largely in a separate publication mainly focusing on epidemiological data (Wittchen et al., 2011).

The list of all diagnostic groups (ICD-10 codes) included in the study is presented in Table 2.

Geographical scope

All 27 members of the European Union (EU27) and Iceland, Norway and Switzerland are included in this study. These 30 countries are two more than in the EBC2005 study (Andlin-Sobocki et al., 2005) in which Bulgaria and Romania were not

Number of persons

The total number of persons with any of the 12 previously reviewed group of disorders of the brain was estimated at 179 million (Table 4). In the EBC2005 study this estimate was lower (127 million) (Andlin-Sobocki et al., 2005). About 10.4% of this difference is explained by the increase in the underlying population, i.e. the population increase in each country from 2004 to 2010 and the addition of Bulgaria and Romania which were not included in the EBC2005 study. The remaining difference is

Addictive disorders

Substance-use disorders in general refer to hundreds of specific diagnostic classes stratified by the type of substance (ranging from opiates to caffeine to alcohol and nicotine) as well as the specific clinical diagnostic condition (ranging from intoxication, over delirium and withdrawl syndrome to abuse and dependence). For our survey only few classes of substances could be considered, namely alcohol, opioid drugs and cannabis as well as only two types of diagnoses, namely abuse and

Main findings

This study provides the currently best possible estimates of the cost of disorders of the brain in Europe in the year 2010, based on the latest available evidence. In comparison to our previous 2005 estimate based on a more restricted set of diagnoses as well as a smaller European reference population, we showed that the estimate presented in the EBC2005 study remains quite stable if correcting for inflation and the increase in the population. The 2004 estimate of €386 billion translates into

Conclusion and recommendation for political action

In the 27 EU countries plus Norway, Iceland and Switzerland with a population of 514 million people, we have estimated that cost of disorders of the brain is €798 billion per year. This cost burden corresponds to 25% of the direct health care expenses and the non-medical direct cost as well as the indirect costs, such as lost work time, are higher than for most other diseases due to the persisting nature of many brain diseases. In total, probably one third of all health related expenses are

Role of the funding source

Unrestricted funding.

Contributors

See below under acknowledgments.

Conflict of interest

None of the authors have conflicts of interest associated with the work reported in this paper.

Acknowledgments

We gratefully acknowledge the unrestricted financial support from the European College of Neuropsychopharmacology, the European Federation of Neurological Societies and from H. Lundbeck A/S.

We acknowledge the enormous and unpaid efforts of the epidemiological and economic experts who have worked voluntarily on this study: Stefanie Drabsch (University of Florence, Italy), Manfred Döpfner (University of Cologne, Germany), Simon Forstmeier (University of Zürich, Switzerland), Andrea Gabilondo

References (441)

  • J. Christensen et al.

    Incidence and prevalence of epilepsy in Denmark

    Epilepsy Res.

    (2007)
  • O.C. Cockerell et al.

    The cost of epilepsy in the United Kingdom: an estimation based on the results of two population-based studies

    Epilepsy Res.

    (1994)
  • M. De Zélicourt et al.

    The contributing factors to medical cost of epilepsy: an estimation based on a French prospective cohort study of patients with newly diagnosed epileptic seizures (the CAROLE study). Active coordination of the longitudinal observational network in epilepsy

    Seizure

    (2000)
  • A. Abela et al.

    Estimated prevalance of dementia in the Maltese Islands

    Malta Med. J.

    (2007)
  • AccessEconomics

    The Cost of Muscular Dystrophy. Muscular Dystrophy Association

    (2007)
  • C. Adelow et al.

    Newly diagnosed single unprovoked seizures and epilepsy in Stockholm, Sweden: first report from the Stockholm Incidence Registry of Epilepsy (SIRE)

    Epilepsia

    (2009)
  • J.L. af Geijerstam et al.

    Mild head injury — mortality and complication rate: meta-analysis of findings in a systematic literature review

    Acta Neurochir. (Wien.)

    (2003)
  • S. Ancoli-Israel et al.

    Sleep-disordered breathing in African–American elderly

    Am. J. Respir. Crit. Care Med.

    (1995)
  • K. Andersen et al.

    Prevalence of very mild to severe dementia in Denmark

    Acta Neurol. Scand.

    (1997)
  • P. Andlin-Sobocki et al.

    Cost of addiction in Europe

    Eur. J. Neurol.

    (2005)
  • P. Andlin-Sobocki et al.

    Cost of psychotic disorders in Europe

    Eur. J. Neurol.

    (2005)
  • P. Andlin-Sobocki et al.

    Cost of affective disorders in Europe

    Eur. J. Neurol.

    (2005)
  • P. Andlin-Sobocki et al.

    Cost of anxiety disorders in Europe

    Eur. J. Neurol.

    (2005)
  • P. Andlin-Sobocki et al.

    Cost of disorders of the brain in Europe

    Eur. J. Neurol.

    (2005)
  • Andrée, C., Stovner, L., Steiner, T., et al., 2011. The Eurolight study on the impact and burden of primary headache in...
  • B. Ares et al.

    Prevalence of multiple sclerosis in Santiago de Compostela (Galicia, Spain)

    Mult. Scler.

    (2007)
  • R. Balakrishnan et al.

    The burden of alcohol-related ill health in the United Kingdom

    J. Public Health (Oxf.)

    (2009)
  • R. Balasa et al.

    The prevalence of multiple sclerosis in Mures County, Central Romania

    Rev. Rom. Neurol.

    (2007)
  • C.M. Baldwin et al.

    The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study

    Sleep

    (2001)
  • C.M. Baldwin et al.

    Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study

    J. Clin. Sleep Med.

    (2010)
  • F. Barth et al.

    Indirect costs in idiopathic Parkinson's disease

    Fortschr. Neurol. Psychiatr.

    (2005)
  • U. Baumhackl et al.

    Prevalence of multiple sclerosis in Austria. Results of a nationwide survey

    Neuroepidemiology

    (2002)
  • L.B. Bdzan et al.

    Prevalence of dementia in a rural population

    Psychiatr. Pol.

    (2007)
  • P.E. Bebbington et al.

    The European Schizophrenia Cohort (EuroSC): a naturalistic prognostic and economic study

    Soc. Psychiatry Psychiatr. Epidemiol.

    (2005)
  • K. Beesdo et al.

    Mood episodes and mood disorders: patterns of incidence and conversion in the first three decades of life

    Bipolar. Disord.

    (2009)
  • K. Beesdo et al.

    Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder

    Arch. Gen. Psychiatry

    (2010)
  • E. Beghi et al.

    Antiepileptic drugs as ‘tracers’ of disease. A calculation of the prevalence of epilepsy through an analysis of drug consumption. The Group for the Study of Epilepsy in General Practice

    Neuroepidemiology

    (1991)
  • E. Beghi et al.

    Direct cost of medical management of epilepsy among adults in Italy: a prospective cost-of-illness study (EPICOS)

    Epilepsia

    (2004)
  • C. Behan et al.

    The economic cost of schizophrenia in Ireland: a cost of illness study

    Ir. J. Psych Med.

    (2008)
  • A. Beilmann et al.

    Prevalence of childhood epilepsy in Estonia

    Epilepsia

    (1999)
  • I. Benavente et al.

    Prevalence of epilepsy amongst adolescents in Huesca, Spain: a community-based study

    Eur. J. Neurol.

    (2009)
  • K. Bencsik et al.

    The prevalence of multiple sclerosis in the Hungarian city of Szeged

    Acta Neurol. Scand.

    (1998)
  • J. Bentzen et al.

    Prevalence of multiple sclerosis in Denmark 1950–2005

    Mult. Scler.

    (2010)
  • J. Berg et al.

    Cost of migraine and other headaches in Europe

    Eur. J. Neurol.

    (2005)
  • J. Berg et al.

    Cost of trauma in Europe

    Eur. J. Neurol.

    (2005)
  • J. Berg et al.

    Costs and quality of life of multiple sclerosis in Sweden

    Eur. J. Health Econ.

    (2006)
  • M. Bertelli et al.

    New contributions of psychiatric research in the field of intellectual disabilities

    Adv. Psychiatry

    (2009)
  • P. Berto et al.

    Cost-of-illness of epilepsy in Italy. Data from a multicentre observational study (Episcreen)

    PharmacoEconomics

    (2000)
  • I. Bielen et al.

    Prevalence of epilepsy in Croatia: a population-based survey

    Acta Neurol. Scand.

    (2007)
  • E.O. Bixler et al.

    Effects of age on sleep apnea in men: I. Prevalence and severity

    Am. J. Respir. Crit. Care Med.

    (1998)
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