The burden and cost of disorders of the brain in Europe with the inclusion of harmful alcohol use and nicotine addiction |
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| Authors: | Tobias Effertz Karl Mann |
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| Affiliation: | 1. Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany;2. Institute of Medical Sociology and Social Medicine, Philipps-University, Marburg, Germany;3. Epilepsy Center, Department of Neurology, Friedrich-Alexander University, Erlangen, Germany;1. Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK;2. School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK;3. School of Clinical Medicine, University of Cambridge, Cambridge, UK;4. Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain;5. Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK;6. Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy;7. "Aldo Ravelli" Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy;8. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA;9. Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche", University of Milan, Milan, Italy;10. General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Germany;11. Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany;12. Departments of Psychiatry, Neuroscience and Child Study, Yale University School of Medicine, and Wu Tsai Institute, Yale University, New Haven, USA, New Haven, USA;13. Connecticut Council on Problem Gambling, Wethersfield, USA;14. Connecticut Mental Health Center, New Haven, USA;15. Department of Psychiatry, Faculty of Medicine, University of Southampton, UK;p. Southern Health NHS Foundation Trust, Southampton, UK;q. SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa;r. Institute of Psychology, University of Lausanne (UNIL), Lausanne, Switzerland;s. Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar;t. Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary;u. Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, Research Group S:TEP (Substance use and related disorders: Treatment, Epidemiology and Prevention) University of Lübeck, Lübeck, Germany;v. Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain;w. Autism and Obsessive Compulsive Spectrum Program, Psychiatric Research Institute at Montefiore-Einstein, Albert Einstein College of Medicine;x. Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, 00135 Palanga, Lithuania;y. Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland;z. Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland;11. Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland;12. Department of Clinical Pharmacological and Biological Science, University of Hertfordshire;13. College of Education, Psychology, & Social Work, Flinders University, Adelaide, Australia;14. SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town;15. Department of Psychiatry & Behavioral Neuroscience, University of Chicago;16. Albert Einstein College of Medicine and Montefiore Medical Center, New York, USA;17. INS Istituto di Neuroscienze, Florence, Italy;18. Cambridge University, UCL and NHS National Centre for gaming Disorders;19. Deptartment of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada;110. Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK;111. Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands;112. Post-Trauma Center, Sheba Medical Center, Tel Aviv University, Israel;113. Reichman University, The Data Science Institution, Herzliya, Israel;114. Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands;115. Amsterdam Institute for Addiction Research & Arkin, the Netherlands;1p. Department of Neuroscience, Imaging and Clinical Sciences, G. D''Annunzio University, Chieti, Italy;1q. Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal;1r. Center for Psychology at University of Porto (CPUP), University of Porto, Porto, Portugal;1s. School of Health and Social Work, University of Hertfordshire, Hatfield, UK;1t. Macedonian Academy of Sciences and Arts, Skopje, MK, Macedonia;1u. Department of Psychology and Cognitive Science, University of Trento, Trento, Italy;1v. School of Information and Communication Studies, University College Dublin;1w. Brain Park, Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging Facility, Monash University, Melbourne, Victoria, Australia;1x. Institute of Psychology, University of Lausanne, Lausanne, Switzerland;1y. Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany;1z. Independent researchers;1. QIMR Berghofer Medical Research Institute, Royal Brisbane and Women''s Hospital, 300 Herston Road, Brisbane, QLD, 4006, Australia;2. Centre for Advanced Imaging, The University of Queensland, St Lucia, QLD, 4072, Australia;3. School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia;4. Queensland Brain Institute, The University of Queensland, St Lucia, QLD, 4072, Australia;5. Imaging Genetics Center, Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, 2001 North Soto Street – Room 102, Marina del Rey, Los Angeles, CA 90032, United States;6. Brain & Mind Research Institute, The University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia;7. Faculty of Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia |
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| Abstract: | Recent publications calculated an annual prevalence of 38% of the population within the European Union having a “disorder of the brain” including substance use disorders (SUD) (Wittchen et al., 2011). The overall economic burden was estimated at 789 billion € (Gustavsson et al., 2011). While these calculations included alcohol dependence, harmful use of alcohol, a common ICD-10 diagnosis, was not considered appropriately. Tobacco related figures were completely left out. We hence estimated burden and costs of these diagnoses for the European Union by extrapolating basic figures from Germany, which have average proportions of alcohol and tobacco related consumption and prevalence rates. Several German Data sets were used to estimate prevalence, disability adjusted life years (DALYs) and Cost-of-Illness for alcohol and tobacco use disorders in Germany. Results were obtained by focussing on the burden of SUD including well-known comorbidities. Results were then extrapolated to the European level. Compared with the earlier estimations DALYs increased from 2.8 million to over 6.6 million for SUDs. Costs augmented from 65.68 billion € PPP to about 350 billion € PPP. We discuss the robustness and validity of our findings under different assumptions and with regard to methodology. We further took into account that in the new DSM 5 alcohol abuse and alcohol dependence – and similar tobacco – will be collapsed into one category of “alcohol related disorder”. If added to the burden and cost calculations the substance use disorders rank on top of all disorders of the brain in Europe. Regardless of the calculation procedure our figures represent lower estimates and have to be regarded as conservative approaches. |
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