Health Economics and Technology Assessment Research Centre Katalin Érsek 1, Krisztián Kárpáti 1, Tibor Kovács 2, László Gulácsi 1 1 Corvinus University of Budapest, 3 Semmelweis University, Clinics of Neurology 19th Alzheimer Europe Conference Brussels, 28-30th May 2009 Epidemiology and Disease Burden of Dementia in Hungary

Content Epidemiology of dementia in Hungary International context Cross-sectional study in 2008 Aim: to investigate epidemiology, health status, health care utilisation and costs of dementia in Hungary Results Health Economics and Technology Assessment Research Centre

Dementia in Hungary Based on the estimation of the demented in Hungary there is a noticeable difference between the domestic and the internationally published data According to international data of Hungary the number of demented is about 100 thousand – UNDERESTIMATION? (Wimo, Winblad, Jönsson 2007) According to previous Hungarian studies, the number of the demented vary between 530 and 917 thousand –OVERESTIMATION? (Ersek et al 2009) Health Economics and Technology Assessment Research Centre

Cross-sectional study design Questionnaires used The Hungarian modified version of the Resource Utilization in Dementia (RUD) questionnaire to evaluate the resources and costs by disease severities – with extra questions MMSE score as an indicator of the cognitive status The validated Hungarian version of the EQ-5D questionnaire to evaluate the patients’ and their caregivers’ quality of life. Health Economics and Technology Assessment Research Centre

Methods With an outlook for the international literature and the available Hungarian information estimating the epidemiology of dementia in Hungary by age-groups and disease severity then make the estimation for the total population. Assigning the disease-related costs to the patients we estimated the burden of dementia in Hungary – with cost issues calculated by the cross-sectional survey in 2008.

Cross-sectional study design II. Sample From 4 GP practices from 4 different cities and 1 outpatients setting of the Neurology Department - 88 consecutive patients and care givers were included – with interviewers’ guidance Baseline data Patients’ mean age was 78 years (SD: 8,5 years), 59% were female. The average disease duration was 3 years (SD: 2,9 years), average MMSE score was 16,7 (SD: 7,24), while EQ-5D was 0,401 (SD: 0,327). The caregivers’ mean age was 60 years and 72,7% of them were female. Average EQ-5D is 0,78. 39,7% of caregivers had part or full time job and 60,2% of them lived together with the patient. Health Economics and Technology Assessment Research Centre

Result: epidemiology and costs Epidemiology Based on a previous GP-setting’s survey (2001) the estimated prevalence of dementia in 2008 is for the 50-59, 60-69, and above 80 years age-groups are 7%, 29%, 39% and 55%, respectively. As for the MMSE categories we can estimate 32% of the demented patients in the MMSE category 0-19 and 68% of patients in MMSE group in Cost estimation In the 2008 survey the average direct cost per patient was 278 EUR (sd. 532), while the indirect cost per patient amounted to EUR 52 (sd. 187). The average direct cost for the 65-75, the and the 85+ age-groups were the following: EUR160, EUR283 and EUR419 respectively. Health Economics and Technology Assessment Research Centre

Results: Comparing QoL values (General population data: Szende A, Németh R. 2004)

Results: Average EQ-5D scores by MMSE categories and age-groups (n=88)

Distribution of cost-issues

Results: costs by MMSE categories and age-groups (n=88) Age-groups (1 = below 65 yrs, 3 = yrs, 4 = yrs, 5 = ≥85yrs)

Conclusions The estimated total direct cost of dementia in 2008 could result 0.25% from the GDP, furthermore 0.05% as indirect cost There is a huge difference between the domestic and the internationally published data – that effect the cost of illness and financing issues. Our survey can inform policy-makers, but it is a strong need for an extensive research to establish an effective and sustainable ageing policy management and financing in Hungary

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