Velandia Paola Pedroza, Miller-Petrie Molly K, Chen Carina, Chakrabarti Suman, Chapin Abigail, Hay Simon, Tsakalos Golsum, Wimo Anders, Dieleman Joseph L
Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, USA.
Center for Alzheimer Research, Karolinska Institutet, Stockholm 17177, Sweden.
EClinicalMedicine. 2022 Mar 13;45:101337. doi: 10.1016/j.eclinm.2022.101337. eCollection 2022 Mar.
The global burden of dementia is increasing. As diagnosis and treatment rates increase and populations grow and age, additional diagnosed cases will present a challenge to healthcare systems globally. Even modelled estimates of the current and future healthcare spending attributable to dementia are valuable for decision makers and advocates to prepare for growing demand.
We modelled healthcare spending attributable to dementia from 2000 to 2019 and expected estimated future spending from 2020 to 2050 under multiple scenarios. Data were from the Global Burden of Diseases 2019 study and from two systematic literature reviews. We used meta-regression to estimate the fraction of dementia spending that is attributable to dementia for those receiving nursing home-based care and for those receiving community-based care. We used spatiotemporal Gaussian process regression to account for data missingness and model diagnosis and treatment rates, nursing home-based care and community-based care rates, and unit costs for the many countries without their own underlying estimates. Projections of future spending estimate a baseline scenario from 2020 to 2050 based on ongoing growth. Alternative scenarios assessed faster growth rates for dementia diagnosis and treatment rates, nursing home-based care, and healthcare costs. All spending is reported in 2019 United States dollars or 2019 purchasing-power parity-adjusted dollars.
Based on observed and modelled inputs, we estimated that global spending on dementia increased by 4.5% (95% uncertainty interval: 3.4-5.4%) annually from 2000 to 2019, reaching $263 billion (95% uncertainty interval [UI] $199- $333) attributable to dementia in 2019. We estimated total healthcare spending on patients with dementia was $594 billion (95% UI $457-$843). Under the baseline scenario, we estimated that attributable dementia spending will reach $1.6 trillion (95% UI $0.9-$2.6) by 2050. We project it will represent 11% (95% UI 6-18%) of all expected health spending, although it could be as high as 17% (95% UI 10-26%) under alternative scenarios.
Health systems will experience increases in the burden of dementia in the near future. These modelled direct cost estimates, built from a relatively small set of data and linear time trends, highlight the magnitude of health system resources expected to be used to provide care and ensure sufficient and adequate resources for aging populations and their caretakers. More data are needed to corroborate these important trends.
痴呆症的全球负担正在增加。随着诊断和治疗率的提高以及人口的增长和老龄化，新增的确诊病例将给全球医疗系统带来挑战。即使是对当前和未来痴呆症相关医疗支出的模型估计，对于决策者和倡导者为不断增长的需求做准备也很有价值。
我们对2000年至2019年痴呆症相关的医疗支出进行了建模，并在多种情景下预测了2020年至2050年的预计未来支出。数据来自《2019年全球疾病负担研究》以及两项系统文献综述。我们使用元回归来估计接受养老院护理和社区护理的人群中痴呆症支出占痴呆症相关支出的比例。我们使用时空高斯过程回归来处理数据缺失问题，并对许多没有自身基础估计值的国家的诊断和治疗率、养老院护理和社区护理率以及单位成本进行建模。未来支出预测基于持续增长情况估计了2020年至2050年的基线情景。替代情景评估了痴呆症诊断和治疗率、养老院护理和医疗成本的更快增长率。所有支出均以2019年美元或经2019年购买力平价调整后的美元报告。
基于观察到的和建模的输入数据，我们估计2000年至2019年全球痴呆症支出每年增长4.5%（95%不确定区间：3.4 - 5.4%），2019年痴呆症相关支出达到2630亿美元（95%不确定区间[UI]为1990亿 - 3330亿美元）。我们估计痴呆症患者的总医疗支出为5940亿美元（95% UI为4570亿 - 8430亿美元）。在基线情景下，我们估计到2050年痴呆症相关支出将达到1.6万亿美元（95% UI为0.9万亿 - 2.6万亿美元）。我们预计它将占所有预期医疗支出的11%（95% UI为6 - 18%），尽管在替代情景下可能高达17%（95% UI为10 - 26%）。
卫生系统在不久的将来将面临痴呆症负担增加的情况。这些基于相对少量数据和线性时间趋势构建的模型直接成本估计，凸显了预计用于提供护理并确保为老年人口及其照料者提供充足资源的卫生系统资源规模。需要更多数据来证实这些重要趋势。
