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9 December 2008: Lunch debate "The rising cost of dementia"

Alliance activities

Jan Tadeusz Masiel

Jan Tadeusz Masiel (MEP, Poland) hosted Alzheimer Europe’s fourth lunch debate in European Parliament and began the proceedings by explaining that the lunch debates had become something of a tradition between Alzheimer Europe and the European Alzheimer’s Alliance, enabling a platform for discussion about Alzheimer’s disease within the European Parliament. Great interest was shown by some 45 participants, including 13 MEPs and /or their assistants attending as well as national Alzheimer Associations, representatives of permanent representations and pharmaceutical companies.

Commenting on the launch of the third Dementia in Europe Yearbook which focuses on social support, socio-economic cost, psycho-social interventions and prevention, Mr Masiel reflected that each of the three Alzheimer Europe Yearbooks had been launched at European Parliament lunch debates. The launch of the first Yearbook, which presented the number of people suffering from dementia in Europe, access to treatment and reimbursement for treatment for Alzheimer’s disease, was hosted in 2006 by Astrid Lulling, (MEP, Luxembourg). In 2007 the second Yearbook was launched at a lunch debate hosted by Françoise Grossetête (MEP, France). The publication presented the first part of the European Collaboration on Dementia project results on support systems to patients and their caregivers was hosted by Françoise Grossetête, (MEP, France).

Highlighting additional ways in which MEPs have the opportunity to be kept informed about Alzheimer’s disease, Mr Masiel spoke of the 80 MEPs who had already pledged their support to fight Alzheimer’s disease by signing the Paris Declaration, which lists Alzheimer Europe’s political priorities, or/and becoming a member of the European Alzheimer’s Alliance.

Jean Georges

Jean Georges, Executive Director of Alzheimer Europe, thanked Mr Masiel for hosting the meeting and talked about the work of Alzheimer Europe, highlighting the EuroCoDe project and also explained how MEPs can help people with dementia. Launching issue 2 of the Dementia in Europe magazine, Mr Georges stressed that the magazine focuses on European policy on dementia and that a large proportion of this issue has been dedicated to coverage of the recent French Conference, saying that he found it both truly inspiring and humbling to receive the unequivocal backing of a European plan from no less than the President of France as well as Ministers from various European countries.

Finally, Mr Georges spoke of Alzheimer Europe’s recently completed EuroCoDe project, which had been funded by the European Commission under their Health Programme and introduced Anders Wimo, who was the leader of the socio-economic cost of Alzheimer’s disease work package within EuroCoDe.

Presenting the aims of the EuroCoDe work package 8 as being to firstly identify reports on the socio-economic cost of dementia and subsequently to produce a report on the cost of dementia within the European Union, Anders Wimo explained that their report on the cost of dementia had been calculated for three groups: (a) EU27 (b) EU27 plus the candidate countries (Croatia, Former Yugoslav Republic of Macedonia and Turkey) plus EEA (Norway, Iceland and Liechtenstein) plus Switzerland and (c) the whole of Europe (including amongst others Russia). The working group identified 14 papers for inclusion in their cost model, from which four different care patterns had emerged (a) Northern (Denmark, Ireland Scandinavia, Sweden and the UK), (b) Western (Belgium, France, Germany and the Netherlands), (c) Southern (Italy, Spain and Turkey) and (d) Eastern (Hungary). For countries where no cost of illness figures were available the working group used imputation.

Anders Wimo

Future cost calculations will be affected by the predicted increase in prevalence rates. The group found that prevalence forecasts for the whole of Europe have risen from just over 4 million people with dementia in 1970, to 8 million in 2005 with predictions of over 12 million people with dementia by 2030 and that prevalence is higher in women than men. This is because there are more women than men, but also because being female is a risk factor for dementia. They also found a similar rate of increase reflected worldwide with figures rising from 15 million in 1970 to 110 million by 2050, with a dramatic exponential increase being expected in the developing countries.

Defining what constitutes a cost is controversial but Mr Wimo said that his group looked at two types of cost (a) direct costs such as medical (e.g. hospital care, drugs) and non-medical costs (e.g. nursing, home care, home services) (b) indirect costs such as production losses of patients and of unpaid informal carers. Mr Wimo said that quantifying informal costs is a big issue and not easy to achieve. The group noted that the cost of illness figures are merely descriptive as they do not include anything about cost effectiveness.

From the table 1, it can be seen that the group found that the total cost of dementia in the whole of Europe in 2005 amounted to EUR 141 billion, or on an annual basis, table 2 shows the cost to be EUR 16,770 per person with dementia: In these cases, the majority of the cost is for informal care. However, when the costs are examined at a regional level (see table 3|) it can be seen that the direct costs are greater for the Northern and Western regions than the Eastern and Southern regions, with the cost of informal care being significantly greater than the direct costs in the Southern region.

Table 1: Cost of illness (in €billion, 2005)

 

Direct costs

Informal care

Total costs

EU 27

57.3

72.7

130.0

EU 27 +

60.9

74.8

135.7

Europe

63.3

77.7

141.0

Table 2: Annual cost of illness per person with dementia (€ , 2005)

 

Direct costs

Informal care

Total costs

EU 27

9,272

11,773

21,045

EU 27 +

9.186

11,280

20,466

Europe

7,485

9,194

16,779

Table 3: Regional cost of illness of dementia (million €. 2005)

 

Direct costs

Informal care

Total costs

Northern

27,667

13,234

40,901

Western

22,327

20,497

42,824

Eastern

3,881

4,806

8,686

Southern

9,386

39,171

48,557

Total

63,260

77,708

140,968

The figures, he said, illustrate the magnitude of the costs of informal care and he went on to give a personal example of informal care, showing a photograph of his great-grandmother with his great aunt Christine. Mr Wimo told participants that Christine had left Sweden and successfully set up a new life for herself in the US. However, when his great-grandmother wrote to her to ask her to come home, Christine did so and took care of her for 30 years and this was considered a natural thing to do then. He then posed the question that in our modern societies with so much migration, who will be there to care in future generations. Mr Wimo believes that this will be a key challenge facing people with Alzheimer’s disease.

Looking at the costs comparatively, Mr Wimo asked for caution as comparisons are not often so easy to make and he emphasised the importance of transparency, as it is essential to understand the basis of the calculations if you are going to compare them. The working group considered other cost estimates which had given a cost per person with dementia in Europe and these ranged from EUR 11,000 to EUR 28,000. In comparison to the rest of the world, the working group found that Europe has the highest cost of dementia, followed by Asia and North America but that the cost per person is highest in North America and Europe is placed third.

Comparisons were made with other illnesses. Dementia was the higher cost (EUR 141 billion) when compared to the cost of depression (EUR 121 billion). From table 4 it can be seen that the cost of dementia in Europe is in second place both on a per case basis (after strokes) and on a cost of illness basis (after alcohol).

Table 4: Cost of brain disorders (EBC report, European Journal of Neurology 2005; 12 (suppl. 1, 1-27)

2004

Per case (€/year)

Cost of illness (Million €, PPPs)

Dementia

10,722

55,176

Anxiety

350-1,804

41,372

Stoke

16,569

21,895

Schizofrenia

7,688

35,229

Alchohol

5,876

57,274

Looking at the difference between the more developed regions, less developed regions and least developed countries, the cost burden of the disease was also compared by using the measurement of “disability adjusted life years” (DALYS) which is a measure of the overall disease burden frequently used by the World Health Organisation (WHO). Diabetes was then compared to dementia by using the DALYs and Alzheimer’s disease and dementia were found to be a higher burden than diabetes in all three EU categories. The figures showed, said Mr Wimo, that dementia creates great disability throughout the world.”

Mr Wimo concluded that the group had found the societal costs of dementia in the EU to be enormous and if treatment remains the same then the cost will rise from EUR 130 billion to EUR 200 billion by 2030. He highlighted the need for much more data from Eastern Europe to help make the figures more meaningful. They also found informal care to be a substantial part of the total cost of dementia and that the quantification of informal cost is crucial for any cost estimates.

Jean Georges thanked Anders Wimo for his interesting presentation, as well as Mr Masiel and Agnieszka Szczesniak for their help in hosting and preparing this lunch debate.

Closing the lunch debate Jan Tadeusz Masiel offered his heartfelt appreciation to Mr Wimo for his excellent presentation, saying that the EuroCoDe project had managed to provide a clear picture on a subject often difficult to grasp: namely the socio-economic costs of Alzheimer’s disease and he went on to say that the results will be an essential basis for the work of political actors at both a national and European level. He shared Mr Wimo’s concern regarding future carers noting that in the next decades there will be less and less people in the labour force which will create a major challenge for the elderly. Mr Masiel stressed the importance of fully understanding all aspects of the disease and of working closely with the European Commission to find a solution to the problems faced by patients and caregivers. He also praised the role played by national Alzheimer associations calling their contributions “vital for us all”.

 

December 2008 Lunch Debate "The rising cost of dementia"

 
 

Last Updated: lundi 26 mars 2012

 

 
 

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