Pugliatti_EU Neurology 09/03/2010 13:24 Page 122
International Health
Figure 1: Estimated Number of Cases of Brain Disorders
Indirect costs were €12.6 billion (31%), mostly due to production loss
in Italy, 2004
4
for sick leave. The total cost of brain disorders (direct and indirect)
represented 3% of the country’s gross national product.
6,000,000
Cost of Brain Disorders per Inhabitant
5,000,000
The overall cost of brain disorders per Italian citizen has been
4,000,000
estimated at €706 per year. A more detailed breakdown is provided in
Table 4.
3,000,000
Discussion
Number of cases
2,000,000
In this review, the estimated cost of 12 brain disorders in Italy in
2004 highlights a relevant economic burden for the country, as it
1,000,000
accounts for up to 3% of gross national product and costs each
citizen €706 per year.
0
a
aine u
m
Stroke
a Psychiatric disorders account for more than half of the total
Migr
Tr
Dementia
Epilepsy
Addiction s disease
ain tumour
costs, especially psychotic and affective disorders. Schizophrenia
Br
in particular is one of the most costly psychiatric illnesses.
8
Anxiety disorders
Affective disorders
Multiple sclerosis
Psychotic disorders P
arkinson’ Anxiety and migraine are fairly inexpensive per single patient
but, due to their high prevalence, they are very expensive at a
The number of cases of stroke and trauma is based on incidence data. Results on addiction
societal level.
omit nicotine dependence.
With permission from Springer-Verlag.
While affective disorders are the most costly brain disorders in
Europe,
3
dementia is the most costly brain disorder in Italy. This
Figure 2: Cost per Patient of Specific Brain Disorders in
difference can be explained by an underestimation of the number
Italy, 2004
4
of affective disorders in Italy due to scarce epidemiological reports
50,000
in relation to cultural attitudes. Italians are less prone than other
45,000
Europeans to consider depression a medical problem and thus
worthy of medical care. A survey has shown that medical advice in
40,000
view of the depressive symptoms was never sought by 62% of the
35,000
subjects classified as suffering from major depression.
9
However,
30,000
having three or more physician visits and drug therapies was twice
25,000
as common and having four or more instrumental examinations
20,000
was three times as common in patients with major depression
15,000
Cost per patient (€ 2004)
compared with non-depressed individuals. Significant loss of
10,000
productivity at work or as part of global activities was four times
5,000
more common in patients with major depression than in non-
0 depressed individuals.
aine
T
umour Stroke
T
r
auma
Alcohol consumption is widespread in Italian communities, and a
Dementia
s disease
Epilepsy
Addiction
Migr
large proportion of the population drinks above the World Health
Organization (WHO)-established cut-off, i.e. 40g/day for males and
Multiple sclerosis
P
arkinson’
Affective disorders
Anxiety disorders
Psychotic disorders 20g/day for females.
10
‘Heavy drinking’ is significantly higher in
females compared with males, with regional differences that are
With permission from Springer-Verlag.
important to consider from a socioeconomic perspective. In the
(€12.4 billion) and neurosurgical disorders (€1.0 billion). Dementia was past 20 years, Italian lifestyles have changed radically, and alcohol
the most expensive brain disorder (€8.6 billion). Among the habits have changed, with increased consumption especially in
neurological disorders, migraine was most costly (€3.5 billion), the young adult female population; this can be attributed to
followed by stroke (€3.4 billion) and epilepsy (€2.3 billion). Direct women’s emancipation and a social levelling-off between the
medical costs were the leading cost item for psychiatric and genders.
11
From a health economic perspective, the burden of
neurosurgical disorders, direct non-medical costs for dementia and high alcohol consumption must be viewed not only as a ‘brain’
indirect costs for neurological disorders. disorder (dependence) but also as a cause of increased morbidity
(hepatic cirrhosis, gastrointestinal disorders, cardiomyopathy,
Cost of Brain Disorders by Resource Items poly-neuropathy, haemorrhagic stroke and mortality); its burden
These data are presented in detail in Table 3. Direct medical and accounts for up to 5% of the gross national product of industrialised
non-medical costs amounted to €17.1 billion and €11.1 billion, European countries.
12
respectively, or 42 and 27% of total costs, respectively. Brain
disorders represented 14% of the total direct healthcare costs in Gerzeli and co-workers
13
have estimated that the societal costs in
Italy, with 7% of the total drug sales attributed to the treatment of the first six months following stroke were €11,600 per patient, 53%
brain disorders. of which was direct medical costs, 39% direct non-medical costs
122 EUROPEAN NEUROLOGICAL REVIEW
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