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Burden of brain disorders ignored by government

Head for numbers: research into brain disorders is seriously underfunded. Pennstatenews

According to various large-scale studies conducted by the World Health Organization, about a third of the adult worldwide population suffer from a mental disorder such as depression, anxiety and schizophrenia.

Taken together with neurological disorders, such as dementia and stroke, these “disorders of the brain” account for 13% of the global disease burden. This surpasses both cardiovascular diseases (5%) and cancer (10%).

Such statistics may be surprising as there is a general lack of awareness regarding the pervasiveness of brain disorders. However, global data or even just within the European Union, can only serve as a wake-up call.

Matching data to policy

And since the amount of money available to invest in health research is restricted in times of economic austerity, government policy to tackle the problem in the UK must be based on specific cost data.

A recent study we carried out in collaboration with researchers from University of Cambridge, Hertfordshire University, Imperial College London, University College London, University of Leeds and University of Manchester revealed that the total estimated cost of major brain disorders in the UK was about £112 billion in 2010.

This estimate was derived from “bottom-up” calculations where possible: the total number of diagnosed cases in the UK - about 45m - was multiplied by the health cost per person calculated from interviews, questionnaires and medical records collected on each major brain disorder.

Due to limitations in data, the costs for certain disorders were not included. Therefore, the estimate of the total cost can be considered conservative. Our study also provides estimates for the total costs incurred by individual brain disorders.

The five most expensive disorders

In 2010, the five most expensive disorders in the UK were: dementia (£18.6 billion), mood disorders (£16.1 billion), psychotic disorders (£14 billion), addiction (£9.8 billion) and anxiety disorders (£9.8 billion). Using this data when planning and implementing national health policies will ensure that money is spent in the right place and as efficiently as possible.

Particular attention should be paid to dementia, which was the most expensive brain disorder. In view of an ageing population, we can only expect these costs to increase in future.

Another study which directly compared the costs of dementia in the UK with stroke, cancer and coronary heart disease (CHD) estimated that the cost of dementia on the social care system was significantly higher. Combining health and social care, informal care and productivity losses, dementia had the highest annual cost at £23 billion, followed by cancer (£12 billion), CHD (£8 billion) and stroke (£5 billion).

More importantly, our study found that about half of overall health costs of brain disorders were indirect, for example lost economic productivity due to work absence or early retirement. The remaining costs were divided equally between direct healthcare costs, for example visits to the doctor, hospitalisation and medicines, and direct non-medical costs such as use of social services, special accommodation and informal care.

This implies that more effective treatment, both pharmacological and psychological, has the potential to considerably reduce the overall economic burden to society but also improve patients’ quality of life. This is a clear argument for investing in research that leads to a better understanding of how to most effectively prevent, diagnose early, treat and manage brain diseases.

Although we have made great progress in understanding the brain within the last few decades, there are still substantial gaps in our knowledge, which hinders development of more effective treatments and preventive interventions for such neuropsychiatric disorders.

The true economic burden

However, despite UK government recommendations that health research priorities should be informed by the size of a disease’s impact on the population and economy, the majority of health research funding in the UK has historically been directed towards cancer (£590m).

Research spending on brain disorders, such as dementia (£50m) and stroke (£23m), has been comparatively seriously underfunded.

The reasons for these disparities are not well understood and are likely to be complex. They may include ignorance of the magnitude of brain disorders, an historical sense of tolerance or therapeutic nihilism (“what’s the point?”) as well as marginalisation and stigma associated with certain brain disorders.

In addition, the worldwide withdrawal of pharmaceutical companies from key areas of clinical neuroscience research poses an additional threat for the advancement of treatments for brain disorders.

We need to transform how funding is allocated, with the focus on distributing funding according to the overall economic burden of the diseases.

And we now have substantial knowledge about brain disorders and excellent technology to make rapid advances to further understand the underlying mechanisms of brain disorders, new treatments and prevention. Given appropriate resources, we could improve brain health for all members of society based on sound evidence.

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