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Other European cost of illness estimates

Cost of dementia

The Dementia Worldwide Cost Database

Background

This is a cost model based on a combination of prevalence estimates, country and region specific data on Gross Domestic Product per person and average wage with results from previously published cost-of-illness studies in different key countries with detailed data. All costs are updated to 2008 €s. Purchase Power Parities (PPPs) (1) were used for currency conversions.

This COI-approach (where Anders Wimo and Linus Jönsson were authors to the original paper together with Professor Bengt Winblad) is based on the Dementia Worldwide Cost Database (DWCD), which has been used for worldwide estimates, (2, 3) but it is here used with a focus on EU (EU25) and Europe (EU25 was in focus when the original paper was written). The classification of European regions is based on the UN classification. However, in that system that was used when the DWCD was developed, Cyprus was classified as a part of Western Asia. In this report Cyprus is positioned as part of Southern Europe. The figures for Cyprus are also included in the EU25 figures. The original cost model year is 2005, but the prevalence figures has been updated to 2008 (with the same source for the age class prevalence figures as in the original paper) and the cost figures have been adjusted to 2008 with the same method as described earlier in this report.

Direct medical and non-medical costs as well as costs for informal care were included. The results from “key countries” regarding direct costs (2) (based on 14 studies (4-17)) were extrapolated to other countries where dementia specific cost figures not are known.

Twenty-seven studies were identified where the amount of informal care was presented in different ways (combinations of PADL, IADL and supervision) (4-8, 15, 17-37). Based on 11 studies (4, 7, 15, 17, 38-44) an average institutionalisation rate was estimated. Based on these studies, it was assumed in the base-case that 1.6 hours per day of informal care in terms of personal ADL is provided to 73% of the demented in the advanced economies. Due to methodological issues, figures of instrumental ADL (on average 3.7 hours per day) and supervision (7.4 hours per day) was not included in the base option, but in the sensitivity analysis. The base option for caregivers of working age is based on the human capital approach, valuing informal care by the average wage by country. In the sensitivity analysis, opportunity costs, based on 21 studies resulted in an average hourly cost of € 9.92/hour (4-8, 15, 17, 19-25, 28, 34, 45-49).

Results

In the base case, the total costs of informal care in Europe is 33 billion € (27 billion € in EU25) (table 13), with a range from 2,202 to 5,148 € per case and year, depending of region.

Table 13. Estimate of the costs of informal care (base case) in 2008

 

Prevalence (x1000)

Costs € 2008 (billions)

Per case

Eastern Europe

2751

6.1

2202

Northern Europe

1307

6.7

5148

Southern Europe

1991

8.0

3995

Western Europe

2544

12.1

4756

Europe

8592

32.8

3822

EU25

6074

27.1

4468

However, as seen in table 14, both the quantification and costing of informal care has a great impact of how the costs of informal care are estimated, illustrating how complicated this issue is and how crucial it is that the calculations are transparen.t

Table 14. Sensitivity analysis of informal care costs (billions €).

 

Base case (PADL, 1.6 hours/day)

PADL + IADL

(3.7 hours per day)

PADL +

IADL + Supervision (7.4 hours per day)

Eastern Europe

6.1

14.0

28.0

Northern Europe

6.7

15.6

31.1

Southern Europe

8.0

18.4

36.8

Western Europe

12.1

28.0

56,0

Europe

32.8

77.9

151.9

EU25

27.1

62.8

125.5

Abbrevations: PADL=Personal activities of daily life, IADL=Instrumental ADL.

In summary, the total societal costs of dementia in Europe were estimated to 103 billion € where informal care in the base case constituted about one third of the costs (table 15). The average annual cost per demented is 12000 € in Europe and about 14000€ in EU25.

Table 15. Summary of total societal costs of dementia care (base cases, in 2008.

Major areas/regions

Prevalence (x1000)

Direct costs

(billions €)

Informal care (billions €)

Total costs (billions €)

Total costs per demented (€)

Eastern Europe

2751

12.6

6.1

18.7

6796

Northern Europe

1307

14.3

6.7

21.0

16077

Southern Europe

1991

16.8

8.0

24.7

12418

Western Europe

2544

26.8

12.1

38.9

15280

Europe

8592

70.5

32.8

103.3

12022

EU25

6074

58.6

27.1

85.8

14119

The costs per demented in single European countries in the DWCD model are seen tin table table 16). The costing approach for regions are dependent on the GDP per person and do not take into account different traditions of care, family patterns etc . Some countries with high GDP figures per citizen, as e.g. Luxembourg and Norway, can, as a consequence of the model, be regarded as outliers.

Table 16. Costs of dementia (€PPPs) in Europe in 2008

 

Direct

Informal

Total

costs

care

costs

Costs

Country

x1000000

x1000000

x1000000

per case

Eastern Europé

       

Belarus

318,0

134,5

452,5

4800

Bulgaria

304,3

124,9

429,3

5053

Czech republic

906,0

383,5

1289,5

12206

Hungary

719,7

370,8

1090,5

10348

Poland

1565,0

987,4

2552,4

7477

Republic of Moldavia

33,8

2,7

36,5

1286

Romania

528,5

254,1

782,7

4033

Russian federation

6132,5

2494,2

8626,7

6924

Slovakia

290,0

122,6

412,7

9128

Ukraine

1838,2

1181,2

3019,3

5974

       

Northern Europé

       

Denmark

832,0

639,5

1471,5

20915

Estonia

83,2

40,1

123,3

9716

Finland

732,0

183,6

915,6

13382

Iceland

41,7

15,3

57,0

19495

Ireland

545,6

182,9

728,6

20374

Latvia

125,6

48,8

174,4

7644

Lithuania

224,4

88,2

312,6

8535

Norway

1004,9

415,2

1420,1

21593

Sweden

1461,9

560,6

2022,5

13703

UK

9235,3

4556,3

13791,5

16334

       

Southern Europé

       

Albania

27,5

12,9

40,5

2844

Bosnia and Herzegovina

69,0

98,9

167,9

5610

Croatia

208,8

170,9

379,7

8322

Greece

1275,9

591,4

1867,3

11967

Italy

8898,5

4179,4

13078,0

14330

Malta

26,3

15,8

42,1

11323

Portugal

837,5

215,8

1053,2

8735

Serbia and Montenegro

212,4

123,1

335,5

3680

Slovenia

157,8

92,2

250,0

12117

Spain

5011,4

2433,1

7444,5

12798

TFYR Macedonia

41,4

18,8

60,2

4222

Cyprus

65,2

41,2

106,4

12659

       

Western Europé

       

Austria

1165,4

549,6

1715,0

17020

Belgium

1461,9

732,5

2194,4

15549

France

8879,1

2890,6

11769,7

13842

Germany

12041,7

6220,1

18261,8

15847

Luxembourg

117,0

25,3

142,3

29179

The Netherlands

2031,3

1026,6

3057,9

15821

Switzerland

1072,8

653,3

1726,2

17103

European Brain Council (EBC) report

Background

European Brain Council was formed in 2003 by European neurologists, psychiatrists, psychologists, neurosurgeons, basic neuroscientists, patient organizations and industrial research. The EBC presented in 2005 a study called Cost of Disorders of the Brain in Europe (50). The project included the EU25 and Iceland, Norway and Switzerland. One of the members of WP8, Linus Jönsson, was also a member of the EBC and was one of the authors of the dementia part of the EBC project (51). With permission from the EBC, we here present the cost figures for dementia. The EBC costing model is similar to the model presented above, but has more inputs, since more data were available. It has four basic components: 1) Time transformation of economic data to 2004 with consumer price index as inflator. 2) Adjustment for international comparisons by Purchasing power parities (PPPs) to Euros (€). 3) Imputation of data for countries in Europe where no cost data were available with different algoritms and 4) where the data sets were combined to estimate the cost of illness in Europe.

The cost per case is here adjusted to 2008 with the same method as described earlier in this report.

Results

Table 17. Costs of dementia in Europe according to EBC

Country

Prevalence

COI mill € PPPs 2004

Cost per case

€ PPSs 2004

Cost per case

€ PPSs 2008

 

Austria

79882

1094

13635

14787

 

Belgium

140351

2175

15435

16044

 

Cyprys

5337

50

9311

10686

 

Czech Republic

90640

672

7374

10811

 

Denmark

50978

752

14690

15677

 

Estonia

13651

45

3265

4087

 

Finland

50750

989

19480

20937

 

France

629014

3865

6084

6824

 

Germany

912145

11616

12735

13644

 

Greece

115393

1181

10193

11670

 

Hungary

99557

711

7111

7866

 

Iceland

2148

25

11694

14880

 

Ireland

28015

310

10984

12939

 

Italy

617122

8648

13957

14952

 

Latvia

23470

98

4144

5646

 

Lithuania

32364

122

3758

5099

 

Luxembourg

3994

69

17187

18519

 

Malta

3134

21

6795

7637

 

Netherlands

207701

3098

14854

15858

 

Norway

43180

711

16363

18503

 

Poland

277013

1301

4672

5168

 

Portugal

110211

1083

9785

11020

 

Slovakia

39560

178

4464

5597

 

Slovenia

18662

148

7870

8653

 

Spain

506592

5145

10107

10371

 

Sweden

98107

115

11240

11664

 

Switzerland

72324

1392

19177

19621

 

UK

614957

8563

13864

15620

 

Europé

4886252

55176

10722

11766

 

As seen in table 17, the COI-figures in this model are lower than in the base option and in the DWCD model.

Country specific cost studies

There are several country-specific COI-studies published regarding dementia. There are sometimes difficulties in identifying the included cost categories (such as direct costs, costs of informal care). In some studies are also stage specific costs presented. The table below (table 18) is a list of the studies where cost per case figures are included. Due to classification and transparency issues, some of the studies below are included in the base COI model, but some studies not.

Table 18. Cost of illness studies from different European countries

Country

Cost per case (€2008 PPP)

Reference

Belgium

14877

(52)

Denmark

11193

(53)

Finland

34946

(54)

France

6718

(55)

France

25119

(56)

Germany

12582

(57)

Ireland

11572

(58)

Italy

54764

(59)

Italy

29982

(60)

Nordic

15428

(61)

Norway

18394

(51)

Spain

27623

(62)

Spain

30556

(63)

Sweden

27568

(51)

Sweden

11553

(51)

Sweden

27773

(64)

Sweden

34036

(65)

Sweden

38406

(66)

The Netherlands

11031

(67)

UK

70804

(68)

UK

35682

(69)

UK

38780

(70)

uk

15415

(71)

UK

18562

(72)

UK

4747

(73)

UK

30814

(74)

UK

39616

(75)

UK

40938

(76)

Discussion

The great range in the cost figures highlights the need for transparency in cost of illness studies.

As compared to the Alzheimer Europes´s yearbook of 2008, the cost of illness in the main option in this report is considerably higher. The main reason is that we have changed prevalence source, from Eurodem to Eurocode´s new figures, which results in a considerably higher estimate of the number of people affected by dementia. This change accounts for more than 75% of the cost increase (the other part is due to a change in costs of care per patient and a real prevalence increase between 2005 and 2008, irrespective of prevalence source).

As seen in tables 15 and 17, the figures are in general somewhat lower in the EBC database than in the the DWCD database (the correlation coefficient for the countries who are in both databases is 0.79). However, both these modeling approaches present in general lower figures than the main option in this report and the country specific figures (See table 18).

Table 18. Costs per demented person in three major cost models.

 

Cost per case in 2008 ($) in ”Europe”

Main model in this report

17,526

DWCD

12,022

EBC

11,766

Of course there are “true” differences in the cost of illness of dementia in Europe, but two main methodological reasons for the range are obvious: firstly it may be unclear which cost categories that are included, and secondly, the impact of the costing and quantification of informal care is obvious. The differences in included countries, here, classified as “Europe” may also have an impact on the cost figures.

Another very important issue is the quantification and valuation of informal care. The results from the sensitivity analysis of informal care from the DWCD database indeed highlight the need for transparency when informal care is included in the calculations(which it indeed should be!). It is also obvious that there is a great need for tranparency regarding which cost categories/types that are included. A societal perspective is recommended, but in some studies are only the direct costs included.

Nevertheless, the societal costs of dementia in Europe are enormous and has a great impact of the social and health care systems in all countries. Given the demographic forecasts with an increasing number of elderly people and as a consequence, an increasing number of people with dementia, it is obvious that there is a great need for a EU policy regarding dementia.

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Last Updated: jeudi 08 octobre 2009

 

 
  • Acknowledgements

    The EuroCoDe project received financial support from the European Commission. Neither the European Commission nor any person acting on its behalf is responsible for any use that might be made of the following information. Alzheimer Europe also gratefully acknowledges the support it received from Fondation Médéric Alzheimer for this project.
  • European Union
  • Fondation Médéric Alzheimer
 
 

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