Cost of disorders of the brain in Europe
Cost of disorders of the brain in Europe
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DOI：
10.1111/j.1468-1331.2005.01202.x
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发表时间：
2005-06-01
影响因子：
5.1
通讯作者：
Olesen, J
中科院分区：
文献类型：
--
作者：
Andlin-Sobocki, P;Jönsson, B;Olesen, J
背景资料：脑部疾病（精神、神经和神经外科疾病）是疾病和残疾的主要原因之一。然而，在欧洲，对脑疾病的流行病学和经济影响的知识研究相对较少。然而，世界卫生组织的数据表明，在欧洲，脑疾病占所有疾病负担的35%。目的：本研究的目的是估计在欧洲的基础上公布的流行病学和经济证据的大脑疾病的经济成本。第二个目标是找出差距，从而为今后的研究工作提供重点脑疾病的流行病学和经济证据：方法：一个模型的开发，结合联合收割机流行病学和经济数据脑疾病在欧洲（欧盟成员国，冰岛，挪威和瑞士），从而估计其总成本。更具体地说，它包括以下步骤，其中我们：（一）转换和转换现有的经济数据到一个确定的时间段以及货币（E2004）;（二）调整购买力和相对经济规模的具体国家的经济数据;（三）对没有数据的国家的估算数据;（iv）结合流行病学和经济数据，以估计某一特定疾病的总成本;（v）将所有选定疾病的成本相加，得出欧洲的总成本。该模型使用了从欧洲流行病学和脑疾病经济负担的广泛文献综述中收集的数据，这些文献综述由12组欧洲流行病学家和健康经济学家进行。成本数据计算为每位患者的成本，流行病学数据主要报告为12个月的患病率估计值。该模型的国家和国际统计数据来自经合组织（经济合作与发展组织）和欧盟统计局的数据库。结果：在4.66亿人口中，估计有1.27亿欧洲人目前患有脑疾病。2004年，欧洲脑疾病的年度总费用估计为3860亿欧元。仅直接医疗支出总额就达1 350亿埃镑，包括住院（780亿埃镑）、门诊（450亿埃镑）和药品费用（130亿埃镑）。由于大脑疾病和死亡造成的永久性残疾而损失的工作日和生产力损失造成的间接费用为1 790亿埃镑，其中精神疾病最为普遍。直接非医疗费用（社会服务、非正式护理和其他直接费用）共计720亿埃镑，其中精神疾病费用为2 400亿埃镑，占总费用的62%（不包括痴呆症），其次是神经系统疾病（不包括痴呆症），共计840亿埃镑（22%）。神经外科疾病在欧洲脑疾病总费用中所占比例较小，达到80亿欧元。在欧洲，脑疾病的平均成本为每位居民829欧元（基于欧洲4.66亿居民的总人数）。然而，欧洲各国的人均费用不同，一般来说，西欧国家的人均脑疾病费用高于欧盟接纳国家。由于缺乏数据，我们的总成本结果只包括部分直接非医疗成本（如社区护理和非正式护理）和间接成本，并省略了完全无形的成本。例如，我们已经表明，痴呆症的成本增加25%时，包括非正式的护理和多发性硬化症的成本增加至少50%时，包括无形costs.Discussion：在几个国家和特定的脑部疾病的流行病学和卫生经济数据的稀缺性，导致保守的成本项目和人口年龄组。再加上本研究仅限于最常见的脑部疾病，这就得出了这样的结论，即脑部疾病的真正经济成本远远高于我们估计的3860亿欧元，可能在5000 - 7000亿欧元之间。因此，脑部疾病的成本远远高于其他重要的医学领域，如心脏病、癌症和糖尿病。然而，大脑疾病的负担很少被放在一起，而是由每一个单一的诊断报告。如果培训工作、研究经费和卫生保健资源能够根据这一新知识进行分配，那么与大脑有关的活动的经费应该会有相当大的增加。我们的成本估计是根据欧洲目前的经济和流行病学数据作出的最佳估计。然而，我们的研究已经确定了在欧洲，特别是在欧盟接纳国家的脑疾病的流行病学和经济证据的主要缺点。更多的研究，系统的，前瞻性的，协作的性质是需要的，以准确地估计费用的大脑疾病在European.Conclusion：基于广泛的文献综述，本研究提供了最好的估计费用的大脑疾病在欧洲在2004年。在28个国家的4.66亿人口中，有1.27亿人受到至少一种大脑疾病的影响。每年的总费用为3 860亿埃镑（386 000 000 000埃镑）。大脑研究资金、医疗资源分配和医学院的教学比例要小得多。大脑疾病的巨大成本和负担要求在研究、医疗保健和教学方面加大努力。
Background: Brain disorders (psychiatric, neurological and neurosurgical diseases together) figure amongst the leading causes of disease and disability. Yet, the knowledge of the epidemiological and economic impact of brain disorders has been relatively little researched in Europe. WHO data suggest, however, that brain disorders cause 35% of the burden of all diseases in Europe. Objectives: The present study aims at estimating the economic cost of disorders of the brain in Europe based on the published epidemiological and economic evidence. A secondary objective was to identify gaps in both epidemiological and economic evidence on brain disorders thus providing focus for future research efforts.Methods: A model was developed to combine epidemiological and economic data on brain disorders in Europe (EU member countries, Iceland, Norway and Switzerland) and thus estimate their total cost. More specifically, it consisted of the following steps in which we: (i) transformed and converted available economic data to a defined time-period as well as currency (E2004); (ii) adjusted country specific economic data for purchasing power and relative size of economy; (iii) imputed data for countries where no data are available; (iv) combined epidemiology and economic data to estimate the total cost of a defined disease; (v) added the cost of all selected disorders to arrive at the total cost for Europe. The model was populated with data collected from extensive literature reviews in the epidemiology and economic burden of brain disorders in Europe, conducted by 12 groups of European epidemiologists and health economists. The cost data were calculated as cost per patient, and epidemiological data were primarily reported as 12-month prevalence estimates. National and international statistics for the model were retrieved from the OECD (Organization for Economic Co-operation and Development) and Eurostat databases. The aggregated annual cost estimates were presented in Euros for 2004.Results: There are an estimated 127 million Europeans currently living with a brain disorder out of a population of 466 million. The total annual cost of brain disorders in Europe was estimated to E386 billion in 2004. Direct medical expenditures alone totalled E135 billion, comprising inpatient stays (E78 billion), outpatient visits (E45 billion) and drug costs (E13 billion). Attributable indirect costs resulting from lost workdays and productivity loss because of permanent disability caused by brain disorders and mortality were E 179 billion, of which the mental disorders are the most prevalent. Direct non-medical costs (social services, informal care and other direct costs) totalled E72 billion.Mental disorders amounted to E240 billion and hence constitute 62% of the total cost (excluding dementia), followed by neurological diseases (excluding dementia) totalling E84 billion (22%). Neurosurgical diseases made up a smaller fraction of the total cost of brain disorders in Europe, reaching a cost of E8 billion. The average cost of brain disorders in Europe was E829 per inhabitant (based on a total number of inhabitants in Europe of 466 million). However, the cost per inhabitant is different between European countries, and in general cost of brain disorders per inhabitant is higher in Western European countries compared with the EU admission countries. Because of scarcity of data, our total cost results only partially includes direct non-medical cost (e.g. community care and informal care) and indirect costs, and omits completely intangible costs. We have for example shown that the cost of dementia increase with 25% when including informal care and and the cost of multiple sclerosis increases with at least 50% when including intangible costs.Discussion: The scarcity of both epidemiologic and health economic data in several countries and for specific brain disorders have led to conservative inclusions of cost items and population age groups. Together with the restriction of the present study to the most prevalent brain disorders this leads to the conclusion, that the true economic cost of disorders of the brain is substantially higher than our estimate of 386 billion Euros, perhaps in the range 500-700 billion Euros. Brain disorders are, thus, substantially more costly than other important fields of medicine such as heart disease, cancer and diabetes. However, the burden of brain disorders is seldom taken together, but rather reported by each single diagnosis. If training efforts, research funding and health care resources could be allocated according to this new knowledge, a very considerable increase in funding of brain related activities should take place. Our cost estimations are the best possible based on the economic and epidemiological data available in Europe today. However, our study has identified major shortcomings both in the epidemiological and economic evidence on brain disorders in Europe, in particular in the EU admission countries. More research of a systematic, prospective, collaborative nature is needed in order to accurately estimate the cost of disorders of the brain in Europe.Conclusion: Based on extensive literature reviews, the present study provides best possible estimates of the cost of disorders of the brain in Europe in 2004. In 28 countries with a population of 466 million, 127 million were affected by at least one brain disorder. The total annual cost was E386 billion (386 000 000 000). Brain research funding, health care resource allocation and teaching at medical schools are proportionately much smaller. The huge cost and burden of brain disorders calls for increased efforts in research, health care and teaching.