Pugliatti_EU Neurology 09/03/2010 13:25 Page 123
Cost of Brain Disorders in Italy – A Review
Table 2: Cost of Brain Disorders in Italy by Area of Interest
4
Direct Medical Costs Direct Non-medical Costs Indirect Costs Total Cost
Neurosurgical Disorders 594 36 373 1,002
Brain tumour 158 36 373 567
Trauma 436 436
Neurological Disorders 3,473 3,372 5,579 12,424
Epilepsy 495 618 1,196 2,308
Migraine 233 3,297 3,530
Multiple sclerosis 176 688 295 1,159
Parkinson’s disease 935 1,105 2,040
Stroke 1,633 961 792 3,386
Neurological/Psychiatric Disorders 2,297 6,351 8,648
Dementia 2,297 6,351 8,648
Psychiatric Disorders 10,765 1,339 6,608 18,713
Addiction 671 385 400 1,456
Affective disorders 1,874 4,618 6,492
Anxiety disorders 1,941 1,590 3,531
Psychotic disorders 6,279 954 7,234
All Brain Disorders 17,129 11,097 12,560 40,787
All costs in €million (purchasing power parity). Numbers are rounded. With permission from Springer-Verlag.
and 8% indirect costs. Age, disability level and type of hospital ward Table 3: Distribution of Total Cost of Brain Disorders in
were the most significant predictors of such costs.
Italy by Resource Use Components
4
The drug costs for brain disorders account for only 7% of the total
Cost %
Italian drug market. In Italy direct medical costs compared with
Direct Healthcare Costs 17,129 42
non-medical costs were proportionally higher for neurosurgical and
Hospitalisation 9,385 23
psychiatric disorders and for migraine and stroke. The direct non-
Drugs 2,109 5
medical costs especially dominated multiple sclerosis and
Outpatient care 5,440 13
Medical devices 196 0.5
dementia, the difference being due to the clinical features of the
diseases and/or their differential management.
Direct Non-medical Costs 11,097 27
Social services 7,776 19
Informal care 2,164 5
The overall economic burden of brain disorders in Italy, as well as in
Adaptations 945 2
other European settings, is very likely underestimated due to lack
Transportation 212 1
of reliable prevalence and economic data for some disorders.
Total Indirect Costs 12,560 31
Moreover, as for stroke, brain tumour and trauma, the costs are
Sick leave 10,527 26
grossly underestimated as they are based on incidence. The costs
Early retirement 1,156 3
of brain trauma were between €5,622 and €8,951, as predicted from
Premature death 876 2
other European countries. However, based on the Diagnosis Related
Total Costs 40,787 100
Group (DRG) system, the estimated cost of severe brain trauma with
Costs in €million. Numbers are rounded. With permission from Springer-Verlag.
tracheostomy due to prolonged coma was €53,922 in Emilia
Romagna, and €10,134 if based on the DRG for craniotomy due to
Table 4: Cost per Inhabitant of Specific Brain Disorders
trauma, even in patients with a mild to moderate injury. Based on
in Italy, 2004
4
DRG, mildly injured patients admitted to the hospital with head
concussion cost between €2,286 and €4,078. Furthermore, the cost
Brain Disorder Direct Medical Direct Non-medical Indirect Total
of admission to an Italian hospital is €940 per day in neurosurgical Costs Costs Costs Cost
wards and close to €2,000 per day in intensive care units.
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All disorders 298 194 218 706
Epilepsy 40 110 0 150
Methodological Considerations
Stroke 109 17 0 125
Study design, population sampling method and accuracy of
Affective disorders 32 0 80 112
assessment and diagnosis vary among studies. Crude rates reflect
Anxiety disorders 34 0 28 61
Multiple sclerosis 4 0 57 61
different population age structures, and comparisons between age-
Trauma 28 17 14 59
and sex-standardised rates to a common referral population are
Migraine 9 11 21 40
almost always unavailable. Prevalence is not univocally expressed,
Psychotic disorders 16 19 0 35
and estimates can be found as point-prevalence, one-year
Addiction 12 7 7 25
prevalence or lifetime prevalence.
Parkinson’s disease 3 12 5 20
Dementia 3 1 6 10
Most of the cost-of-illness studies considered for implementing the Tumour 8 0 08
cost model were prevalence-based and bottom-up, a design that is Costs in €million (purchasing power parity). With permission from Springer-Verlag.
EUROPEAN NEUROLOGICAL REVIEW 123
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