Pugliatti_EU Neurology 09/03/2010 13:24 Page 121
Cost of Brain Disorders in Italy – A Review
Table 1: Prevalence of ‘Brain Disorders’ in Italy
Brain Disorder Men Women Total Age Group (years) References
Alcohol dependence (per 100) 1.1 0.7 – 15–65 16
Alcohol dependence (per 100) 0.3 0.2 – 14–90 16
Alcohol dependence (per 100) – – 0.1 18+ 17, 18
Drug addiction (per 1000) – – 7–8 15–64 19
Depressive episodes (per 100) – – 6.5 18+ 20
Bipolar type I disorder (mania) (per 100)
a
0.7 1.9 1.3 15+ 21
Bipolar type I disorder (mania) (per 100) – – 0.4 15+ 21
Bipolar type II disorder (hypomania) (per 100)
a
0.0 0.4 0.2 15+ 21
Bipolar type II disorder (hypomania) (per 100) 0.0 0.2 0.1 15+ 21
Cyclothymic disorders (per 100)
a
0.2 1.6 0.4 15+ 21
Cyclothymic disorders (per 100) 0.22 0.56 0.4 15+ 21
Panic disorder (per 100) – – 1.4 15+ 21
Generalised anxiety (per 100) – – 4–7 14+ 21, 22
Social phobia (per 100) – – 3.7 14+ 21, 22
Dementia (per 100)
b
– – 1.2 65–74 15
Dementia (per 100)
b
– – 4.5 75–84 15
Dementia (per 100)
b
– – 32.2 85+ 15
Epilepsy (per 1000)
c
3.5–7.1 3.2–5.2 3.3–6.2 All ages 23
Epilepsy (per 1000)
c
– – 4.5 5–14 23
Headache (per 100)
a
35.5 46.2 46 7+ 24
Headache (per 100)
a
16.5–36.6 26.3–62.1 21.8–51 65+ 24
Headache (per 100)
a
19.9 28.1 23.9 11–14 24
Migraine (per 100)
a
2.3–7.4 6.4–13.8 4.6–11 65+ 24
Migraine (per 100)
a
2.7 3.3 3.0 11–14 24
Tension-type headache (per 100)
a
13.2 18.4 16–44.5 65+ 24
Chronic headaches (per 100)
a
2.5 6.0 4.4 65 + 24
Multiple sclerosis (per 100,000) 68–111 37–50 53–81 All ages 25
Multiple sclerosis (per 100,000)
d
205–208 83–95 144–152 All ages 25, 26
Parkinson’s disease (per 100,000) – – 168–315 All ages 27
Parkinson’s disease (per 100,000) – – 165 35+ 27
Parkinson’s disease (per 100,000) – – 1,500 60+ 27
Stroke (per 100,000) 79–150 42–80 – 25–44 28
Stroke (per 100,000) 868–4,864 548–1,114 – 45–64 28
Stroke (per 100,000) 5,095–9,172 3,416–7,038 – 65–84 28
Stroke (per 100,000) 12,237 10,178 – 85+ 28
a. One-year prevalence; b. Alzheimer’s disease: 50%; vascular dementia: 45%; other types: 5%; c. Active epilepsy (i.e. seizures and/or treatment in the preceding five years);
d. Sardinia, insular Italy.
single disorder was thus the product of the prevalence and the women.
6
As for brain trauma, incidence rates were reported for the
cost per case. When Italian epidemiological and cost data were calendar year 1998 at between 250 and 314 per 100,000 in Romagna
not available for an individual brain disorder, the values were and Trentino, with peaks at one to four, 20–30 and ≥70 years of age.
7
predicted by the model by extrapolating data from other European
countries. Prevalence data were stratified according to age, gender Based on these rates, in Italy the estimated total number of
and disorder severity, if applicable. The validated model and individuals with any of the 12 brain disorders considered was 12.4
prediction methods, as well as the sensitivity analysis to test the million in 2004, i.e. more than 20% of the Italian population. The
cost model, have been described in detail elsewhere.
3,4,5
The key distribution of estimated cases with brain disorders in Italy by clinical
parameters employed in the costing model were tested in a condition is presented in Figure 1.
sensitivity analysis.
Cost per Patient
Results The cost per patient for each of the 12 brain disorders is shown in
Prevalence Figure 2. The highest cost was found for brain tumours and multiple
The CDBE study was based on the prevalence of the 12 brain sclerosis, whereas the lowest was for anxiety disorders and migraine.
disorders as estimated for 2004.
1
Estimates for Italy are reported in
Table 1. No country-specific prevalence data were available at that Total Cost of Brain Disorders.
time for illicit drug dependence and psychotic disorders, including The direct, indirect and total costs of the 12 brain disorders in Italy,
schizophrenia and schizoaffective and delusional disorders. calculated in €PPP million, was estimated at €40.8 billion (see Table 2).
The sensitivity tests gave an estimated cost range of €30.9–51.0 billion.
For brain tumours and trauma, incidence data were also available. The
overall age-standardised incidence rate of malignant brain tumour for The most relevant sources of expenditure were psychotic/affective
Italy was estimated at 6.2 per 100,000 in men and 4.2 per 100,000 in disorders and addiction (€18.7 billion), followed by neurological
EUROPEAN NEUROLOGICAL REVIEW 121
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