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      The size, burden and cost of disorders of the brain in the UK

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          Abstract

          Aim:

          The aim of this paper is to increase awareness of the prevalence and cost of psychiatric and neurological disorders (brain disorders) in the UK.

          Method:

          UK data for 18 brain disorders were extracted from a systematic review of European epidemiological data and prevalence rates and the costs of each disorder were summarized (2010 values).

          Results:

          There were approximately 45 million cases of brain disorders in the UK, with a cost of €134 billion per annum. The most prevalent were headache, anxiety disorders, sleep disorders, mood disorders and somatoform disorders. However, the five most costly disorders (€ million) were: dementia: €22,164; psychotic disorders: €16,717; mood disorders: €19,238; addiction: €11,719; anxiety disorders: €11,687. Apart from psychosis, these five disorders ranked amongst those with the lowest direct medical expenditure per subject (<€3000). The approximate breakdown of costs was: 50% indirect costs, 25% direct non-medical and 25% direct healthcare costs.

          Discussion:

          The prevalence and cost of UK brain disorders is likely to increase given the ageing population. Translational neurosciences research has the potential to develop more effective treatments but is underfunded. Addressing the clinical and economic challenges posed by brain disorders requires a coordinated effort at an EU and national level to transform the current scientific, healthcare and educational agenda.

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          Most cited references63

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          Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study

          The Lancet, 349(9064), 1498-1504
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            The size and burden of mental disorders and other disorders of the brain in Europe 2010.

            To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU. Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY). Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165m vs. 2005: 82m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke. In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century. Copyright © 2011. Published by Elsevier B.V.
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              The global burden for disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020

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                Author and article information

                Journal
                J Psychopharmacol
                J. Psychopharmacol. (Oxford)
                JOP
                spjop
                Journal of Psychopharmacology (Oxford, England)
                SAGE Publications (Sage UK: London, England )
                0269-8811
                1461-7285
                September 2013
                September 2013
                : 27
                : 9
                : 761-770
                Affiliations
                [1 ]Hertfordshire Partnership NHS University Foundation Trust, Queen Elizabeth II Hospital., Welwyn Garden City, UK
                [2 ]University of Hertfordshire, Postgraduate Medicine, Hatfield, UK
                [3 ]University of Cambridge, School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
                [4 ]Greater Manchester West Mental Health NHS Foundation Trust, Cromwell House, Cromwell Road, Eccles, Manchester, M30 0GT
                [5 ]Centre for Lifespan and Chronic Illness Research (CLiCIR), University of Hertfordshire, Hatfield, UK
                [6 ]Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
                [7 ]University of Hertfordshire, Department of Psychology, Hatfield, UK
                [8 ]Division of Brain Sciences, Imperial College, Neuropsychopharmacology, London, UK
                [9 ]Wellcome Department of Imaging, University College London, Institute of Neurology, London, UK
                [10 ]University of Cambridge, Department of Clinical Neurosciences, Addenbrookes Hospital., Cambridge, UK
                [11 ]University of Cambridge, Department of Psychiatry, Addenbrooke’s Hospital, Cambridge, UK
                [12 ]Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
                [13 ]British Association for Psychopharmacology Council Member, UK
                Author notes

                BAP affiliations: Naomi A Fineberg: Secretary for Clinical External Affairs; Peter M Haddad: Honorary General Secretary; Allan H Young: Chair of the Psychopharmacology Special Interest Group of the Royal College of Psychiatrists; David J Nutt: Editor in chief of BAP Journal of Psychopharmacology and Ex-President; Barbara J Sahakian: President of the BAP

                [*]Professor Naomi A Fineberg, Consultant Psychiatrist, Hertfordshire Partnership NHS University Foundation Trust, Queen Elizabeth II Hospital., Howlands, Welwyn Garden City, Hertfordshire, AL7 4HQ, UK. Email: kiri_researchhpft@ 123456yahoo.com
                Article
                10.1177_0269881113495118
                10.1177/0269881113495118
                3778981
                23884863
                aa911105-5ab5-418a-8967-7ee86b1cfb38
                © The Author(s) 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Papers

                Pharmacology & Pharmaceutical medicine
                brain disorders,cost,burden
                Pharmacology & Pharmaceutical medicine
                brain disorders, cost, burden

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