Conclusions and policy implications
Cost of dementia
The care of dementia presents a great challenge for the EU. Dementia disorders are highly prevalent, extremely costly and cause a great burden for both patients and caregivers. In a situation where the financial resources in the health care and social security systems are put under a great stress and with an increasing number of demented, it is important to discuss how to improve care and cost-effectiveness of care. The relation between the progression of the disease, formal and informal care is complex. It is obvious that there are different care patterns across Europe where the proportions of formal care and informal carers vary. The proportion of institutional care in the formal care system also vary and since institutional care is a heavy cost driver, this factor has a great impact of the cost estimates.
How these factors interact depends on the organisation of care and since the care patterns vary across EU, it is fundamental to discuss each country´s local prerequisites for dementia care.
For policy reasons, COI studies cannot be used for setting priorities (for a comprehensive view of the cost-effectiveness issue, the governmental Swedish Health Technology institute, SBU has published a comprehensive evidence based report on Dementia, where health economic aspects is an important part (1)). However, COI studies can highlight differences between countries, changes over time and how the cost burden is distributed among different payers including informal carers.
One great problem is that COI data are completely missing from several countries, particularly from Eastern Europe. In that perspective, the results from Hungary in this report are of very great interest.
It is also obvious that the imputations and adjustments according to GDP per person do not take care traditions and care cultural patterns into account. This is particularly of great importance when the role of informal care is under discussion.
The health economic database of dementia is still small, although expanding and the methodological problems are obvious. The number of studies of the economic burden is restricted to few European countries and particularly the situation in Eastern Europe need to be highlighted more. There are several established research networks in the EU, e.g. this project Eurocode via Alzheimer Europe and EADC (European Alzheimer Disease Consortium), European Association of Geriatric Psychiatry, European Federation of Neurological Sciences, but there is a great need for even better collaboration and also a stable funding of research including health economic research on the socio-economic impact of dementia. The national initiatives taken in Sweden, France and Germany as well as the EU initiative highlighted at the presidency conference in Paris on October 30-31 2008 can indeed be regarded as a good start.
- SBU. Dementia. A systematic review. Stockholm: Staten beredning för medicinsk utvärdering (SBU) (The Swedish Council on Technology Assessment in Health Care) 2008. Report No.: 172E/1-3.
Last Updated: jeudi 08 octobre 2009