Economic aspects related to prevention, treatment, and care of elderly persons

a. Costs of treatment and care for dementia. Eldercare, and in particular treatment of people with dementia, generates high societal costs throughout the care system. For disorders such as dementia that affect people over long periods of time, it is difficult to collect data over the whole course of the disease. Therefore there is a strong argument for simulation studies. We use simulation studies to verify whether a treatment that can modify the disease course could be beneficial for the individuals and at the same time reduce the societal burden. In a first study¹, we show an uneven distribution of dementia costs at different disease stages. Social care services are responsible for those people with the most severe problems and the highest care costs. Then, using Markov modeling, we reported that giving dementia-specific treatment would benefit individuals, but that the societal cost would rise. This rise would mainly be accounted for by an increase in longevity of one year for people undergoing the treatment. The rise in societal costs is considered to be within acceptable limits, as the cost of the treatment per Quality Adjusted Life Year (600,000 SEK) is under the level required for the treatment to be considered cost-effective by society².

b. Cost-effectiveness of potential dementia preventive intervention programs starting at midlife. We have estimated the cost-effectiveness of a potential dementia prevention program using the CAIDE Dementia Risk Score and a Markov model adapted to Swedish conditions³. The prevention program consisted of two main components, a health promotion program and pharmacological treatment of cardiovascular risk factors. Figures on costs and mortality were obtained from literature or databases. The multi-domain preventive intervention was less costly and resulted in better dementia-related outcomes than “usual care,” supporting the conclusion of cost-effectiveness.

c. Occurrence and cost of brain disorders in the European Union. In a collaborative European project, the 12-month prevalence and disability burden of a broad range of mental and neurological disorders in the European Union (EU) were estimated based on a stepwise multi-method approach. The findings showed the true size of the burden from “disorders of the brain” was considerably larger than expected, as brain disorders represent the largest contributor to the all-cause morbidity burden as measured by disability-adjusted life years (DALYs) in the EU⁴. Furthermore, the total cost of disorders of the brain in Europe in 2010 was estimated at €798 billion. Direct costs constituted the majority of costs, whereas the remaining 40% were indirect costs associated with patients’ production losses. On average, the estimated total cost for each person with a brain disorder in Europe ranged between €285 for headaches and €30,000 for neuromuscular disorders⁵.

1. Sköldunger A, Wimo A, Johnell K. Net costs of dementia in Sweden – an incidence based 10 year simulation study. Int J Geriatr Psychiatry 2012; 27(11):1112-1117.
2. Sköldunger A, Johnell K, Winblad B, Wimo A. Mortality and treatment costs have a great impact on the cost-effectiveness of disease modifying drugs in Alzheimer’s disease. Curr Alzheimer Res 2013; 10(2):207-216.
3. Zhang Y, Kivipelto M, Solomon A, Wimo A. Cost-effectiveness of a health intervention program with risk reductions for getting demented: results of a Markov model in a Swedish/Finnish setting. J Alzheimers Dis 2011; 26(4):735-744.
4. Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jönsson B; CDBE2010 study group; European Brain Council. The economic cost of brain disorders in Europe. Eur J Neurol 2012; 19(1):155-162.
5. Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, et al. CDBE2010Study Group. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011; 21(10):718-779.