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Cost of illness and burden of dementia - The base option

Cost of dementia

by Anders Wimo, MD, PhD, professor, Karolinska Institutet, Linus Jönsson, PhD, I3 Innovus and Anders Gustavsson, Senior Analyst, I3 Innovus

Search strategies for the cost of illness estimates

A literature search was conducted for papers reporting data on costs of care for patients with diagnosed dementia or possible/probable Alzheimer’s disease.

Two approaches were used, the first includes bottom-up data, the second includes top-down cost-of-illness studies or similar.

The advantage with the bottom-up approach is that it allows stratification on disease severity and different cost types. This analysis is based on Jönsson-Wimo (1). For European specific studies, Medline, EMBASE and Current Contents were searched for the following terms (in any field):

(Dementia OR Alzheimer*) AND (Cost OR Economic) AND (Europe* OR Austria OR Belgium OR Cyprus OR Czech Republic OR Denmark OR Estonia OR Finland OR France OR Germany OR Greece OR Hungary OR Ireland OR Italy OR Latvia OR Lithuania OR Luxembourg OR Malta OR Netherlands OR Norway OR Poland OR Portugal OR Slovakia OR Slovenia OR Spain OR Sweden OR Switzerland OR United Kingdom)

As part of i.a the Swedish council on technology assessment in health care´s (SBU) dementia project (2), a general search including both bottom-up studies and top-down studies was conducted in PubMed/Medline, Ingenta, Cochrane Library, NHSEED/THA, HEED, PsycINFO, ERIC, Societal services abstracts and Sociological abstracts. The search terms (MESH/Subheadings when appropriate) were dementia/Alzheimer´s disease/Alzheimer disease combined with costs, economics.

More than 500 references were identified in the first rounds. Many Irrelevant papers could be removed by title reading. The abstracts of the remaining papers were then reviewed manually.

The cost of illness and burden of dementia are here presented in three ways:

  • for EU 27,
  • for EU27 + candidate countries (Croatia, Former Yugoslavic republic of Macedonia and Turkey) + countries in the European Economic Area (Norway, Iceland, Liechtenstein) + Switzerland,
  • for the whole of Europe and regions according to the classification by United Nations (UN).

In the Alzheimer Europen Yearbook of 2008, we presented cost estimates for 2005 (3). We have now updated the figures to the situation in 2008. The prevalence figures, which are used for the cost of illness estimates, are now in the main option based on the new metaanalysis by Eurocode (see another section of this report) but other prevalence sources are presented in the sensitivity analysis: metaanalyses by Eurodem (4), Ferri et al (5),the Swedish health Technology assessment institute SBU (5) and Lobo et al (7) . In short, the new Eurocode prevalence figures result in a greater number of demented people, particularly of female. These age specific prevalence figures are combined with population figures from UN (8). The Eurostat provides more new and up-to-date population statistics but since it ends with the age class 85+, we regarded it as more feasible to use the UN –figures. However, the UN-figures are based on their worldwide statistics and the figures for the oldest age groups are estimates. However, we compared the UN figures for the age group 80-84 for 2008 with the available Eurostat figures for 2007. The ratio was 1.02, which with is a good agreement if a growth in the number of elderly between 2007 and 2008 is taken into consideration.

In 2008 we estimate that there were about 7.2 million people with dementia in EU27 (Table 1).

Table 1. Prevalence of Alzheimer´s disease and other dementias in Europe in 2008 (millions).

Eurocode prevalence estimated

Prevalence

EU 27

7.22

EU27 + candidate countries , EEA countries and Switzerland

7.82

Europe including Turkey

10.11

Fourteen papers were finally selected as eligible for the European cost model (Table 2).

The key criterium was that i direct costs and informal care costs could be identified.

For countries where no cost of illness figures were available, imputation was used. Four care patterns were identified and used for the imputation representing the relation between formal care (direct costs) and informal care in Northern (mainly formal care), Western (mix between formal and informal care), Southern (mainly informal care) and Eastern Europe (mainly informal care) (based on UN´s region classification of Europe). The imputation figures were also adjusted for differences in GDP per person between countries (9).The cost estimates are also adjusted to the year 2008 by the Eurostat HICP-Health index (Harmonized indeces for consumer prices; Health) (10).

For the countries were such HICP-figures were not available (Albania, Belarus, Bosnia and Herzegovina, Croatia, TFYR Macedonia, Moldova, Russia, Serbia and Ukraine), the CPI sfrom World Economic Outlook were used (11).

Table 2. Included papers in the basic European cost model.

Country/region

Region

Source

Denmark

Northern

(12)

Ireland

Northern

(13)

Scandinavia

Northern

(14)

Sweden

Northern

(15)

UK

Northern

(16)

Belgium

Western

(17)

France

Western

(18)

Germany

Western

(19)

Netherlands

Western

(20)

Italy

Southern

(21,22)

Spain

Southern

(23)

Turkey

Southern

(24)

Hungary

Eastern

(25)

The total cost of illness of dementia disorders in EU27 in 2008 was estimated to 160 billion € (table 3), of which 56% were costs of informal care. The corresponding costs for a wider EU sphere was 167 billion € and 177 billion € for the whole Europe.

Table 3. Cost of illness in Europe (billions €) in 2008 for Alzheimer´s disease and other dementias.
 

Direct costs

Informal care

Total costs

EU 27

71.7

88.6

160.3

EU27 + candidate countries , EEA countries and Switzerland

76.3

91.2

167.5

Europe (including Turkey)

80.6

96.6

177.2

 

 
 

Last Updated: mardi 27 octobre 2009

 

 
 

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