The Cost of Brain Disorder: Individual and Social Cost

OBJECTIVE: To estimate the cost of brain disorders from individual and social aspects. METHOD: This study employed two complementary methodologies for the estimation: individual survey and collective statistics. The survey recruited 1903 disabled persons, staying at home, registered at public health center as brain disorders. They were asked about epidemiologic, clinical variables, medical cost, employment status and pre-/post-morbid incomes. Collective statistics included mortality data from the national statistical office, report on wage structure report from the ministry of labor and national health insurance statistical yearbook from the national health insurance corporation. Individual cost of brain disorders was estimated by summing direct medical cost and indirect cost from productivity loss (job loss or decreased income). Social cost also comprised direct medical cost and indirect cost; indirect cost corresponded to productivity loss due to healthcare utilization, job loss, decreased income and premature death. RESULTS: Individual cost of brain disorders was 164,041,000 Korean Won (KRW) per patient. 93.3% of the subjects of the survey who were pre-morbidly employed lost their job and the income of those who maintained employment decreased to 51.5% of original income on average. Social cost of brain disorder in 2005 was 9,901,057,327,000 KRW. Major part of social cost was due to job loss. CONCLUSION: Brain disorder imposes substantial amount of economic cost, individually and socially. Especially job loss from disability after brain disorder takes up the largest portion. The results of the study are expected to serve as a foundation for future research and healthcare policy.

A complexidade do custo socioeconômico da filariose linfática / The complexity of the socioeconomic costs of lymphatic filariasis

A falta de conhecimento do impacto socioeconômico das diversas doenças é, geralmente, um dos maiores obstáculos para a obtenção de verbas para investimentos em pesquisa aplicada, assim como para iniciar a implementação de programas de controle necessários aos países em desenvolvimento. Os autores analisam e ressaltam aspectos relevantes da complexidade de quantificação do impacto socioeconômico da filariose linfática e enfatizam as lacunas existentes em algumas áreas do conhecimento, que ainda não foram devidamente exploradas para os portadores da doença. Aos dados de literatura aliam os ecos do aprendizado adquirido através do atendimento de pacientes portadores de infecção e doença bancroftiana em serviço terciário de referência do Núcleo de Ensino Pesquisa e Assistência em Filariose (NEPAF), Recife, Brasil. O impacto social, no seu sentido mais abrangente, mostra indícios fortes de perdas na qualidade de vida dos pacientes, infelizmente ainda pouco documentadas e, até certo ponto, de muito difícil contabilização, pelo tão peculiar abandono social das comunidades endêmicas.

Lack of knowledge of the socioeconomic impact of various diseases is generally one of the biggest obstacles to obtaining funds for investment in applied research and for starting to implement control programs that are needed in developing countries. The authors analyze and emphasize important aspects of the complexity of quantifying the socioeconomic impact of lymphatic filariasis. They highlight the gaps that exist within some fields of knowledge and that these gaps have still not been properly explored with regard to individuals with this disease. They bring together the data in the literature and echoes from their own experience gained through caring for patients with Bancroftian infection and disease at a tertiary referral service (NEPAF - Filariasis Care, Research and Teaching Center, Recife, Brazil). The social impact, in its broadest sense, consists of strong indications of losses of quality of life among patients. Unfortunately, this is still poorly documented and, up to a certain point, very difficult to quantify because of the very particular social abandonment of the endemic communities.

Social cost of mental disorders: Disability and work days lost. Results from the Mexican survey of psychiatric epidemiology / El costo social de los trastornos mentales. Discapacidad y días productivos perdidos. Resultados de la Encuesta Nacional de Epidemiología Psiquiátrica

Summary: Introduction. When the impact of illness is evaluated by indicators like mortality, mental illness has a less significant impact than other illnesses. As a result, the impact of mental disorders was underestimated until the last two decades of the previous century This perception began to change as a result of two factors: On the one hand, the study of the Global Burden of Disease reported by Murray and Lopez, and, on the other hand, the definition of mental disorders by the American Psychiatric Association. The common element shared by these two factors is the inclusion of the concept of disability. Disability is the deterioration of the expected functioning of a subject of a particular age and sex in a social context. It is a part of the social cost of illness. Objective. To assess the disability burden associated with depression, mania, agoraphobia, social phobia, general anxiety, panic disorder, and post-traumatic stress disorder (PTSD) according to the Mexican Psychiatric Survey and to compare results with the disability produced by some chronic non-psychiatric conditions. Method. This survey is based on a stratified, multistage area, probabilistic sample of adults living in urban areas of Mexico. The instrument used was the third version of the Composite International Diagnostic Interview. We report the 12-month prevalence of psychiatric disorders as defined by DSM-IV criteria. We also evaluated non-psychiatric chronic conditions like diabetes, arthritis, hypertension, backache, and other painful illnesses, identified in general as "chronic conditions". Indicators of disability were Sheehan's scale and number of work days lost. This is an easy and fast self reporting scale, which can be used both in the clinic or research. The sub-scales can be added or averaged to obtain a total score. The scale of responses is a horizontal line with numerals from 0 to 10 and five verbal descriptions, with the description "Not at all" corresponding to a value of 0; "Mild" rangimg from 1 to 3; "Moderate" from 4 to 6; "Severe" from 7 to 9; and "Very severe" corresponding to 10. Results. Close relationships and social life were the areas most deeply affected. The disorders found to produce the highest levels of disability were depression, social phobia, and PTSD. The lowest disability levels were observed in chronic conditions. On the total score of Sheehan's scale, disorders with the highest level of disability were PTSD (mean 5.35 ± 0.307) and depression (mean 4.72 ± 0.167). Depression and panic attacks were the disorders by which most days were lost on average in the previous year (25.51, CI95: 16.53-34.5; 20, CI95: 3.02-36.97). Days lost were lower in chronic conditions than in the seven mental disorders studied (6.89, CI95: 3.04-10.74). Discussion. This is the first paper to demonstrate the impact of mental disorders in Latin America evaluating the association of disability with common mental disorders. We have shown that mental disorders, especially depression, are associated with deficits in functioning and result in the loss of work days. We have also shown that persons with common mental disorders have, on average, higher levels of disability than those observed among persons with a wide range of chronic physical conditions. These results are consistent with prior studies in North America and Europe that have found that persons with common mental disorders experience substantial disability in social role functioning.

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