Cost estimates of brain disorders in Belgium

This article presents the data on cost of the major brain disorders in Belgium which were retrieved from "Cost of Disorders of the Brain in Europe" study sponsored by the European Brain Council and performed by Stockholm Health Economics. The disorders selected were: addiction, depression, anxiety disorders, brain tumours, dementia, epilepsy, migraine and other headaches, multiple sclerosis, Parkinson's disease, psychotic disorders, stroke and trauma. Figures for prevalence of disorders and direct medical, direct non-medical and indirect costs are based on data coming from available electronic data bases, or when missing for Belgium, best possible estimates or extrapolated data were used. All economic data were transformed to Euro's for 2004 and adjusted for purchasing power parity (PPP). The results show that the total number of people with any brain disorder in Belgium amounts to 2.9 million in 2004, the most prevalent being anxiety disorders 1.1 million, migraine 860000, addiction (any) 800,000 and depression 500,000 cases. The total cost of all included brain disorders in Belgium was estimated at 10.6 billion Euros. Most costly per case are brain tumours, multiple sclerosis, stroke and dementia. Because of their higher prevalence, however depression, dementia, addiction, anxiety disorders and migraine have the highest total costs. Taken together brain disorders consume 4% of the gross national product and cost each citizen of Belgium 1029 Euros per year. The drug costs for brain disorders constitute only 10% of the total drug market in Belgium, and only 4% of the total cost of brain disorders in Belgium. This should be compared to the cost estimates and to a previous study which showed that brain disorders are responsible for 35% of the total burden of all disorders in Europe. This study suggests therefore that the direct healthcare resources, including expenses for drug therapies, allocated to brain disorders in Belgium are not leveled to the indirect costs and burden of these disorders. A comparison with data available from a direct prospective study in demented Belgian patients suggests that the mathematical estimates presented here reflect quite accurately the real average cost for dementia, although there are large variations depending on disease severity. As, in addition, subjects with brain disorders face collateral costs which have not been taken into associations, a complementary survey in the Belgian ecosystem to establish the cost profile of representative patients for the major brain disorders. Such a survey is being organized by a task force of the Belgian Brain Council.     

Costs of brain disorders in Finland

Objective –  To calculate the costs of brain disorders on the national level.
Methods –  Electronic data bases, national registers and internet data.
Results –  Any brain disorder was estimated to affect a fifth of the Finnish population. The three most common disorders were migraine, anxiety disorder and affective disorder. The total costs of brain disorders constituted 3% of the national gross product, or 45% of all the health-care costs. However, this is likely a conservative estimate, because not all chronic brain disorders and not all costs were included. Of the total costs of brain disorders, 32% were for direct health care, 23% for indirect medical care and 45% for indirect costs. Dementia was the most costly individual brain disorder followed by addiction and affective disorders. Most costly per case were brain tumours and multiple sclerosis.
Conclusion –  Brain disorders constitute a costly part of the population's health costs. Directed preventive measures are needed to counteract the population morbidity and to control the increasing cost pressure in health care.     

Activities in the Danish Year of the Brain 1997

In this paper we report about the Danish Year of the brain 1997 because it may serve as a model for other countries. It was possible in Denmark to organize a very large scale effort which has been well received by the general public and which has significantly improved the image of the neurological disciplines. The resources spent on nationwide initiatives in the Danish Year of the Brain are more than 2 million ECU in country with 5 million inhabitants. In addition however considerably amounts were spent in each country of Denmark. Since all professionals have worked for free innumerable hours of work have not been budgeted. In fact the Danish Year of the Brain has been the largest privately organized health campaign ever held in Denmark and it has been so successful that the Danish Heart Association. Which is old well organized and extremely strong financially has been worried about the shift of attention from the heart to the brain.     

What does the developing brain tell us about neural diseases?

In a recently published report, the European Brain Council estimated that the annual cost of brain disorders is larger than the cost of all other disease areas combined, including cardiovascular diseases, cancer, and diabetes. The World Health Organization concluded that approximately one-third of the total burden of disease in Europe is attributable to brain disorders. Therefore, drug development for neural diseases should flourish and attract large pharmaceutical companies and smaller enterprises alike. However, this is far from being the case: industry is cutting down on research and investment in brain disorders in Europe. Political reasons may be contributing to this, but they do not constitute the only explanation. An important reason for the decreasing interest and investment is the lack of drug targets in neural diseases. In order to change this, greater efforts at understanding the etiologies and pathogenetic mechanisms of disorders of both the developing and the adult brain are required. We need to strengthen basic research to understand the brain in health and disease. A shift from translational to basic research is required to meet the need for drugs and therapies in the future. In support of this, I summarize some recent studies indicating that the developing brain has much to offer in this respect. The processes and genes involved in brain development are linked to the etiologies not only of neurodevelopmental but also of neurodegenerative diseases.     

Resource allocation to brain research in Denmark: an example for other European countries

This study represents a first attempt at estimating Danish resource allocation to brain research including both public and private spending. It appears that private spending is at a reasonable level because a highly developed Danish pharmaceutical industry invests significantly in this branch of science. However, public spending is at a low level compared with several other European countries with a similar economic status. As for other European countries the funding is very low compared with the USA. Dedicated national investigations of the resource allocation to different branches of biomedical research are warranted. Brain research should of course be an important part of such studies. The USA and the European Union have selected brain research as one of their priority areas within health-related research. The present figures indicate that this is highly justified and should be copied in Denmark and in all other European countries.     

The economic cost of brain disorders in Europe

Background and purpose: In 2005, we presented for the first time overall estimates of annual costs for brain disorders (mental and neurologic disorders) in Europe. This new report presents updated, more accurate, and comprehensive 2010 estimates for 30 European countries. Methods: One‐year prevalence and annual cost per person of 19 major groups of disorders are based on ‘best estimates’ derived from systematic literature reviews by panels of experts in epidemiology and health economics. Our cost estimation model was populated with national statistics from Eurostat to adjust to 2010 values, converting all local currencies to Euros (€), imputing cost for countries where no data were available, and aggregating country estimates to purchasing power parity–adjusted estimates of the total cost of brain disorders in Europe in 2010. Results: Total European 2010 cost of brain disorders was €798 billion, of which direct health care cost 37%, direct non‐medical cost 23%, and indirect cost 40%. Average cost per inhabitant was €5.550. The European average cost per person with a disorder of the brain ranged between €285 for headache and €30 000 for neuromuscular disorders. Total annual cost per disorder (in billion € 2010) was as follows: addiction 65.7; anxiety disorders 74.4; brain tumor 5.2; child/adolescent disorders 21.3; dementia 105.2; eating disorders 0.8; epilepsy 13.8; headache 43.5; mental retardation 43.3; mood disorders 113.4; multiple sclerosis 14.6; neuromuscular disorders 7.7; Parkinson’s disease 13.9; personality disorders 27.3; psychotic disorders 93.9; sleep disorders 35.4; somatoform disorder 21.2; stroke 64.1; and traumatic brain injury 33.0. Conclusion: Our cost model revealed that brain disorders overall are much more costly than previously estimated constituting a major health economic challenge for Europe. Our estimate should be regarded as conservative because many disorders or cost items could not be included because of lack of data.     

The socio‐economical burden of hypersomnia

Jennum P, Kjellberg J. The socio‐economical burden of hypersomnia.
Acta Neurol Scand: 2010: 121: 265–270.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – In the absence of socio‐economical consequences of hypersomnia this study addresses the factual indirect and direct costs. Methods – Two thousand two hundred and eight patients with a hypersomnia diagnosis from 1998 to 2005 were identified in the Danish national patient registry (NPR), each compared with 4 age and gender adjusted, randomly chosen citizens selected from the Civil Registration System Statistics. The health cost was decomposed in direct and indirect yearly costs, including labor supply and social transfer payments. Direct costs included frequencies and costs of discharges and outpatient use by cost weights according to diagnosis related groups and specific outpatient prices based on data from The Danish Ministry of Health. The use of and costs of drugs was based on data from the Danish Medicines Agency. The frequencies and costs from primary sectors were based on data from The National Health Security. Indirect costs were based on income data from the coherent social statistics (CSS). Results – Patients with hypersomnia presented significant higher health related contact rate, expenses and medication use. No differences were identified in employment and income. The yearly sum of direct and indirect costs were yearly €3402 vs. €1212 in controls (P < 0.001), corresponding to a yearly excess costs €2190. The patients presented higher transfer income, total €889. Conclusion – Hypersomnia patient present higher health and medication uses, and social transfer income and thus represent a significant socio‐economical burden.     

Cost of disorders of the brain in Italy

The aim of this study was to estimate the cost of "brain" disorders in Italy. Country-specific prevalence and health-economic data on addiction, affective, anxiety and psychotic disorders, tumours, dementia, epilepsy, migraine/other headaches, multiple sclerosis, Parkinson's disease, stroke and head trauma were reviewed. Direct medical/non-medical and indirect costs were computed. Population-based samples and national or regional registries were used. The Italian population expected with a brain disorder was 12.4 million in 2004. The highest cost per case was for tumours and multiple sclerosis; the lowest was for anxiety disorders and migraine. Dementia (8.6 billion euros), psychotic and affective disorders (18.7 billion euros), migraine (3.5 billion euros) and stroke (3.4 billion euros) represented the highest total costs. Direct medical costs were predominant for psychiatric and neurosurgical disorders, direct non-medical costs for dementia, and indirect costs for neurological disorders. The total cost of brain disorders in Italy was 40.8 billion euros, 3% of the gross national product, and 706 euros per Italian citizen/year. This figure is however likely to be underestimated as it is based on retrospective methodology and samples of brain disorders, and does not include intangible costs.     

The schizophrenic patient in the somatic hospital

OBJECTIVE: There is an increased risk in schizophrenia for premature death from illnesses in almost all organic systems. The present study analyses the Rate Ratio (RR) for schizophrenic patients' admissions to somatic departments in Denmark. METHOD: 20000 schizophrenic patients were identified in the Danish Psychiatric Central Register and 200000 sex- and age-matched controls were identified in the Danish Central Person Register. Both groups were searched for in the Danish National Patient Register in which admissions to all somatic departments are registered. Pulmonary and cardiovascular diseases are used as examples. RESULTS: RR is increased for several diseases, especially infectious, up to a maximum of RR = 4.15 for severe heart failures and decreased to as low as RR = 0.35 for atherosclerotic diseases of the brain vessels. CONCLUSION: It seems that individuals with schizophrenia are rarely treated for their physical illness in its early, less severe phases, but more likely in its acute phases when the disease is severe, life-threatening or painful.     

Prevalence of mental disorders among 15-17-year-old male adolescent remand prisoners in Denmark

OBJECTIVE: To determine the past year prevalence of mental disorders of 15-17-year-old adolescent remand prisoners in east Denmark. METHOD: One hundred 15-17-year-old boys from east Denmark consecutively remanded during 1 year were interviewed with diagnostic instruments to obtain ICD-10 diagnoses. All were screened in The Danish Psychiatric Case Register and The Danish Criminal Register. RESULTS: Past year prevalence of 'any mental disorder' was 69%, substance use disorders 41%. Two per cent had schizophrenia and 2% schizotypal disorder. Thirty-six per cent had 'probable personality disorder'. Conduct disorder was found in 31% and 1% had a hyperkinetic disorder. Ten per cent had previous registered psychiatric contact. CONCLUSION: The prevalence of mental disorders was found substantially higher compared with literature of population-based samples. With an association between mental disorders and violence, early detection and treatment of mental disorders in adolescent delinquents is of importance in the prevention of violence.     

Incidence of eating disorders in psychiatric hospitals and wards in Denmark, 1970–1993

Two previous studies in Denmark found diverging results in analyzing trends in new cases of eating disorders in the psychiatric in- and day-patient services, although the same data source, the nationwide Danish Psychiatric Case Register, was used. The present study – also using information from the nationwide Danish Psychiatric Case Register, but correcting for several register biases – confirms a highly significant increase in new cases of eating disorders in psychiatric hospitals and wards. The increase is seen exclusively in younger females. The diverging results in the previously mentioned studies in Denmark may be ascribed to methodological issues.     

Economic costs of depression in China

BACKGROUND: A recent survey in China indicated the 12-month prevalence rate of depressive disorders was 2.5% in Beijing and 1.7% in Shanghai. These disorders may result in disability, premature death, and severe suffering of those affected and their families. AIMS: This study estimates the economic consequences of depressive disorders in China. METHODS: Depressive disorders can have both direct and indirect costs. To obtain direct costs, the research team interviewed 505 patients with depressive disorders and their caregivers in eight clinics/hospitals in five cities in China. Depression-related suicide rates were obtained from published literature. The human capital approach was used to estimate indirect costs. Epidemiological data were taken from available literature. RESULTS: The total estimated cost of depression in China is 51,370 million Renminbi (RMB) (or US $6,264 million) at 2002 prices. Direct costs were 8,090 million RMB (or US$ 986 million), about 16% of the total cost of depression. Indirect costs were 43,280 million RMB (or US$ 5,278 million), about 84% of the total cost of depression. CONCLUSIONS: Depression is a very costly disorder in China. The application of an effective treatment--reducing the length of depressive episodes (or preventing episodes) and reducing suicide rates--will lead to a significant reduction in the total burden resulting from depressive disorders. Government policymakers should seriously consider further investments in mental health services.     

The burden of complex genetics in brain disorders

BACKGROUND: Few data estimate the impact of complex genetics in neuropsychiatric illness, making it likely that this impact could be underappreciated. OBJECTIVE: To provide estimates of the impact of complex genetics in neuropsychiatric disorders in the United States, based on estimates of disease costs to US society, disease heritability, and mendelian contributions to disease.Data Sources, Study Selection, and DATA EXTRACTION: Costs were estimated from literature sources and Lewin-National Foundation for Brain Research estimates updated for population growth and consumer price index inflation. Heritability estimates came from available twin data. Estimates of mendelian contributions came from the Online Mendelian Inheritance in Man database and our perspectives. CONCLUSIONS: Brain and nervous system disorders may cost the United States as much as US dollars 1.2 trillion annually, and affect many millions of Americans each year. Twin data suggest that more than 40% of the societal burden of brain disorders is likely to be genetically mediated. Most of this disease burden arises from complex multigene genetics as well as from environmental influences. The large sizes of these complex genetic burdens should encourage careful molecular and clinical work to link disease-vulnerability allelic variants with the pathogenesis, nosologic characteristics, prevention, diagnostics, and therapeutics of brain disorders.     

Brain‐specific fatty acid‐binding protein is elevated in serum of patients with dementia‐related diseases

Background: There is a need for biomarkers in accessible matrices, such as blood, for the diagnosis of neurodegenerative diseases. The aim of this study was to measure the serum levels of brain‐type fatty acid‐binding protein (FABP) and heart‐type FABP in patients with dementia‐involving diseases. Methods: Brain‐ and heart‐type FABP were measured in serum samples from patients with either Alzheimer’s disease (AD) (n = 31), Parkinson’s disease (PD, n = 43), or other cognitive disorders (OCD, n = 42) and in 52 healthy controls. The localization of brain‐ and heart‐type FABP was determined in brain sections by immunohistochemistry. Results: Brain‐type FABP levels were elevated in serum of 29%, 35%, and 24% of the patients with AD, PD, and OCD, respectively, and in 2% of the healthy donors. Heart‐type FABP serum levels were not different amongst the patient groups. Brain‐type and heart‐type FABP expression was observed in reactive astrocytes in brain sections of patients with AD. Conclusions: In contrast to heart‐type FABP, serum levels of brain‐type FABP are elevated in a significant proportion of patients with various neurodegenerative diseases and can therefore have importance for defining subgroups of these patients.     

基于新灰色关联与结构变动度的精神障碍患者住院费用结构分析

目的了解深圳市某精神专科医院2013年-2017年精神障碍患者住院费用的构成及变化趋势,探讨影响住院费用结构变动的主要项目及变化方向。方法收集深圳市某精神专科医院2013年-2017年出院精神障碍患者住院费用信息并建立数据库。运用新灰色关联分析法分析各项目费用与总费用的关联,采用结构变动度分析法分析5年间住院费用的结构变动情况。结果 2013年-2017年精神障碍患者人均住院总费用增加了4 603. 95元,年均增长率为9. 37%。综合医疗服务类费用对总费用的影响最大,其次为诊断类和治疗类费用。5年间住院费用结构变动度为76. 06%,年均结构变动度为19. 02%。影响住院费用结构变动度的主要项目是治疗类、综合医疗服务类和诊断类,三者累计结构变动贡献率为93. 13%。结论总费用构成主要项目由治疗类转为综合医疗服务类,新灰色关联和结构变动度分析法能较好地应用于精神障碍患者住院费用分析。     

Estimating the costs of epilepsy: an international comparison of epilepsy cost studies

PURPOSE: To compare systematically the national and per capita estimates of the cost of epilepsy in different countries. METHODS: Studies for this literature review were selected by conducting a Medline literature search from January 1966 to March 2000. Key methodologic, country-related, and monetary issues of the selected epilepsy cost studies were evaluated to compare their direct cost estimates and to explore their distribution. The results of the selected studies were made comparable by converting them with different types of conversion factors and expressing them as a proportion of the national expenditure on health care. RESULTS: Ten epilepsy cost studies were reviewed. The proportion of national health care expenditure on epilepsy shows a range of 0.12-1.12% or 0.12-1.05% depending on the type of conversion factor. The list of cost components included in the estimation of the direct costs of epilepsy differs from study to study. A comprehensive list is associated with a decrease in the contribution of drug and hospital costs to the total direct costs of epilepsy. CONCLUSIONS: This study highlights the importance of studying the economic consequences of epilepsy and of interpreting the results on the international level. The results of epilepsy cost studies can provide insight into the distribution of the costs of epilepsy and the impact of epilepsy on the national expenditure on health care.     

Therapeutic potential of brain stimulation techniques in the treatment of mental,psychiatric, and cognitive disorders

Treatment for brain diseases has been disappointing because available medications have failed to produce clinical response across all the patients. Many patients either do not respond or show partial and inconsistent effect, and even in patients who respond to the medications have high relapse rates. Brain stimulation has been seen as an alternative and effective remedy. As a result, brain stimulation has become one of the most valuable therapeutic tools for combating against brain diseases. In last decade, studies with the application of brain stimulation techniques not only have grown exponentially but also have expanded to wide range of brain disorders. Brain stimulation involves passing electric currents into the cortical and subcortical area brain cells with the use of noninvasive as well as invasive methods to amend brain functions. Over time, technological advancements have evolved into the development of precise devices; however, at present, most used noninvasive techniques are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), whereas the most common invasive technique is deep brain stimulation (DBS). In the current review, we will provide an overview of the potential of noninvasive (rTMS and tDCS) and invasive (DBS) brain stimulation techniques focusing on the treatment of mental, psychiatric, and cognitive disorders.     

Resource allocation to brain research in Europe (RABRE)

This article is a markedly condensed summary of a longer report [Resource allocation to brain research in Europe (RABRE), part 2] that is simultaneously published on line: (i) as supplementary material linked to this European Journal of Neuroscience article (http://www.blackwell-synergy.com/loi/ejn) and (ii) on the website of the European Brain Council (http://www.europeanbraincouncil.org/publications). We have recently shown that brain diseases account for 35% of the overall disease burden and cost European society almost euro 400 billion per year (a billion is understood to mean one thousand million throughout this report). The aim of the present study was to estimate funding for brain research in Europe and the cost-benefit of further investments in this area of research. The assessment of funding included public sources (governmental agencies plus charities) and industry funding. The assessment of publicly financed research support for brain research was based on a comprehensive survey, and industry investment in brain research was assessed based on published data on pharmaceutical development. The total funding of brain research in Europe was estimated at euro 4.1 billion in 2005, of which public grants amounted to < euro 900 million. Thus, industry funding accounted for 79%. Although cancer only incurred 50% of the cost of brain diseases in 2005, public grants for cancer research were almost twice as high as the public financial support of brain research. US-based funding of brain research was almost four times higher than European funding. We assessed the cost-benefit of further investment in brain research using different methods. They all showed that increased investment in brain research is likely to be highly cost-effective. We conclude that European spending on brain research, particularly public spending, is low compared to other fields of research and to the US, and that increased investment in brain research seems warranted.     

Evaluating the use and limitations of the Danish National Patient Register in register-based research using an example of multiple sclerosis

Mason K, Thygesen LC, Stenager E, Brønnum‐Hansen H, Koch‐Henriksen N. Evaluating the use and limitations of the Danish National Patient Register in register‐based research using an example of multiple sclerosis.
Acta Neurol Scand: 2012: 125: 213–217.
© 2011 John Wiley & Sons A/S. Background – The Danish National Patient Register, Landspatientregistret (LPR), is a register of all hospital discharges and outpatient treatments in Denmark. Aims – It is increasingly used in research so it is important to understand to what extent this can be used as an accurate source of information. Virtually all patients in Denmark with multiple sclerosis (MS) are reported to the Combined MS Registry (DMSR), so this was used as the standard which the LPR was compared against. Methods – All residents of Denmark are assigned a unique Civil Register (CPR) number; this was used to compare data between registers. The LPR completeness was estimated by the proportion of cases from the DMSR that could be retrieved from the LPR. The LPR validity was estimated by the proportion of cases, listed in the LPR and DMSR, in whom the MS diagnosis could be confirmed as definite/probable/possible by the DMSR. Results – We found that 86.9% of those who were DMSR listed with an approved MS diagnosis were also listed in the LPR with a MS diagnosis. The diagnosis was valid in 96.3% of patients listed in the LPR when compared against the DMSR. Conclusions – The low completeness reduces the usefulness of the LPR in epidemiological MS research, in particular incidence studies. The study also found that the completeness of the LPR could be increased to 92.8% by including LPR records from other departments in addition, but this reduced the validity of the LPR to 95.1%. However, these results cannot uncritically be applied to registration of other diseases in the LPR.