The economic burden of dementia in China, 1990-2030: implications for health policy.

TLDR: In China, population ageing and the increasing prevalence of dementia were the main drivers for the increasing predicted costs of dementia between 2010 and 2020, and population ageing was the major factor contributing to the growth of dementia costs between 2020 and 2030.

Abstract: Introduction According to the 2013 Alzheimer's Disease International report, about 44.4 million people were living with dementia in 2013 and this number is expected to reach an estimated 75.6 million by 2030. (1) In China, which has the largest population of people with dementia, the prevalence of dementia appears to have increased steadily between 1990 and 2010. (2,3) However, this trend might be partly attributed to temporal variations in the methods used to estimate such prevalence. (4) The results of a national survey in 2008-2009 indicated that dementia was more common in rural areas than in urban settings. (5) Given the rapid growth of the elderly population in China, (6) dementia is expected to pose tremendous challenges to the national health-care system and to the sustainable development of the national economy. Most cost-of-illness studies for dementia have been carried out in high-income countries such as Sweden, the United Kingdom of Great Britain and Northern Ireland and the United States of America. (7-11) The economic costs of dementia in China --which have yet to be investigated in detail--are likely to differ, both in magnitude and type, from those in such distant high-income countries. In this study, we sought to estimate and predict the costs of dementia in China for the periods 1990-2010 and 2020-2030, respectively. It was hoped that, by quantifying the economic costs of dementia, Chinese policy-makers would be motivated to develop a nationwide action plan, prioritize policies on dementia-related care and research and reduce the economic and societal burdens of dementia in China. Methods In this cost-of-illness study, we used a prevalence-based, bottom-up approach to quantify or predict the costs of dementia in China between 1990 and 2030, from a societal perspective. We categorized all the costs into three classes: (11,13) (i) direct medical costs, that is goods and service costs related to the diagnosis and treatment of inpatients and outpatients with dementia; (ii) direct non-medical costs, that is transport costs and costs related to formal care in nursing homes or informal care at home; and (iii) indirect costs resulting from dementia-attributable loss of productivity. Data sources We used multiple data sources for all estimates. We used age-specific prevalence of dementia in China, for the period 1990-2010, derived from a comprehensive systematic review. (3) From the electronic health records of the facilities, we collected cost data for patients with diagnosed dementia who were admitted either to the Shandong Centre for Mental Health--the only provincial psychiatric hospital in the eastern province of Shandong--between 1 January 2005 and 31 March 2014 or to the Daizhuang Psychiatric Hospital--one of the oldest psychiatric hospitals in China and also in Shandong province --between 1 January 2012 and 30 September 2014. The routine electronic health records include sociodemographic data and data on clinical diagnosis and disease classification, itemized costs, e.g. for drugs, examinations and beds. In each of the two study facilities, dementia was diagnosed and defined according to the International statistical classification of diseases and related health problems, 10th revision. (14) We excluded 26 patients with dementia who were diagnosed as having other chronic conditions that needed treatment, e.g. anxiety, diabetes or hypertension, leaving data from the records of 146 patients with dementia in our analysis. We also searched the China National Knowledge Infrastructure, Pub Med and Wan fang bibliographic databases for studies, on the use of health resource by people with dementia in China, published between 1 January 1990 and 31 July 2015. The search terms included "Alzheimer's disease", "China", "cost burden", "dementia", "economic burden", "formal care" and "informal care". We obtained costs for outpatient visits and transportation from a published study. …