1. Cost of depression in Europe EBC perspective Cyril Höschl Association of European Psychiatrists Centre of Neuropsychiatric Studies, Psychiatric Centre Prague & Charles University, 3rd Medical Faculty, Prague

2. Cost of depression in Europe EBC perspective Cyril Höschl

3. EBC (est. 2002) Mission To promote brain research in Europe and to improve the quality of life of those affected by brain diseases

4. The Growing EBC Membership Ordinary Members (Board members) EANS - European Association of Neurosurgical Societies ECNP - European College of Neuropsychopharmacology EFNA - European Federation of Neurological Associations EFNS - European Federation of Neurological Societies EPA - European Psychiatric Association FENS - Federation of European Neuroscience Societies GAMIAN Europe - Global Alliance for Mental Illness Advocacy Networks 2 Industry representatives Associate Members (non-voting) FEPSCO – Federation of European Psychophysiology and Cognitive Neuroscience Societies EACIC – European Accreditation Committee in CNS B4B – Brains 4 Brain Observers to the Board EDAB - European Dana Alliance for the Brain WHO - World Health Organisation ESN – European Societies of Neuropsychology EUFAMI – European Federation of Associations of Families of People with Mental Illness

5. European Brain Policy Forum A Focus on Depression & the European Society High level opening addresses Keynote speakers Eminent experts to explain their perspectives Attendance by patients from several EC countries Press, MEP’s, EC officials Publication and policy as outcomes

6. National Brain Councils Multidisciplinary action groups Scientists, doctors, patients and industry These National Action Groups could form the nuclei of National Brain Councils in the future Many countries are forming NBC’s Belgium, Italy, Slovenia, Hungary, Norway launched Cyprus, Czech Republic, France, Germany, Lithuania, Malta, Poland, Portugal, Slovakia, Spain in the process Finland, Estonia, Latvia, Sweden targeted for the near future Share aims of the EBC but are independent Focus on national priorities

7. EBC Projects - Past The Burden of Brain Diseases in Europe Olesen J and Leonardi M. Eur J Neurol 2003, 10:471-7. Cost of Brain Disorders in Europe Andlin-Sobocki P, Jonsson B et al. Eur J Neurol 2005, 12 Suppl 1:1-27 Size and Burden of Mental Disorders in Europe Wittchen, H-U et al. Eur. Neuropsychopharmacol 2005, 15(4):355-490. Research Allocation for Brain Research in Europe Sobocki P et al. Eur J Neurosci 2006, 24:1-24. Consensus Document on European Brain Research Olesen J, Baker MG et al. J Neurol Neurosurg Psychiatry 2006, 77 Suppl1:i1-49.

8. Gustavsson A, et al. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011

9. CBDE II Update Media coverage: –More than a 1000 media covered the story –The story was covered in more than 30 countries –More than 20 countries in the EU covered the story –The coverage is continuing and the study is being used in many other stories involving brain disorders –We undertook more than 10 interviews –Five media attended the Brussels event –Six media took part in the UK Science Centre session including the Times, Nature, The Lancet, The Guardian –More than 12,000 people visited the original release from Business Wire –Coverage in the media exceeds hundreds of millions

10. CBDE II Update

11. ECNP/EBC* Report 2011: Cost of Disorders of the Brain in Europe *European College of Neuropsychopharmacology / European Brain Council

12. ECNP/EBC Report 2011 [ Methodology ] Direct successor of a benchmark study of the Cost of Disorders of the Brain in Europe published in 2005 27 European + 3 allied countries [Norway, Iceland, Switzerland] Collaboration between almost a hundred prominent epidemiologists and many expert health economists Based on the best currently available data in Europe, and the best currently available estimates as identified via a systematic review of the soundest studies published Cost model inputs: Statistics from Eurostat, estimates of the prevalence and cost per person, local currencies converted to Euro and adjusted to purchasing power parity (PPP), Data were extrapolated to countries where no data could be found

13. ECNP/EBC Report 2011 [19 major groups of brain disorders covering over 100 specific mental and neurologic disorders] Previously reviewed: Addiction Anxiety disorders Brain Tumor Dementia Epilepsy Headache Mood Disorders [Major depression and bipolar disorder] Multiple sclerosis Parkinson‘s disease Psychotic disorders Stroke Traumatic brain injury Newly reviewed: Child / adolescent disorders Eating disorders Mental retardation Neuromuscular disorders Personality disorders Sleep disorders Somatoform disorders

14. ECNP/EBC Report 2011 [ Results ] €798 billion => €1550 per capita 60% direct costs (37% direct healthcare costs and 23% direct non- medical costs); 40% indirect costs associated with patients‘ production losses Over 160 million people affected – more than 36% of the total region‘s population 26% of DALY – more than from any other group of medical disorders; more than in any other part of the world No evidence for any improvement since previous pan-European study conducted in 2005 The burden of disorder of the brain will likely increase further because of the aging European population.

15. ECNP/EBC Report 2011 Cost of Disorders of the Brain in Europe Focus on: DEPRESSION

16. Cost of depression in Europe Depression is the single most burdensome disorder of the brain The European prevalence of major depression (age 18+): 6,9% The European prevalence of bipolar disorder (age 18-65): 0,9% The overall cost of mood disorders (depression ICD-10 codes: F32, F33 & bipolar disorder: F30, F31): €113.4 billion

17. Mood disorders: Comparison of 2010 and 2004 estimates 2010 Total costs (million, €PPP, 2010): 113,405 Number of subjects (million): 33.3 -Age 18+ for major depression, 18-65 for bipolar disorder -including Bulgaria and Romania Costs per subject (€PPP, 2010): 3406 - Decreased due to the inclusion of a wider age range for major depres- sion – indirect costs at age 18-65 are much higher than at age 65+ 2004 Total costs (million, €PPP, 2010): 105,666 Number of subjects (million): 20.9 -Age 18-65 for all disorders -Bulgaria and Romania not included Costs per subject (€PPP, 2010): 5066

18. Number of persons with mood disorders in European countries: Austria547,449 Belgium691,778 Bulgaria501,200 Cyprus51,604 Czech Rep.693,194 Denmark349,162 Estonia87,238 Finland343,060 France 4,054,124 Germany 5,408,460 Greece741,574 Hungary656,494 Iceland19,447 Ireland272,233 Italy 3,963,790 EUROPE 33,290,962 Latvia148,667 Lithuania217,623 Luxembourg 31,887 Malta 26,884 Netherlands 1,052,351 Norway304,011 Poland 2,499,229 Portugal692,059 Romania 1,402,169 Slovakia355,049 Slovenia135,176 Spain 3,002,725 Sweden 597,797 Switzerland 507,641 United Kingdom 3,936,897

19. Cost per persons with mood disorders in European countries (€PPP, 2010): Austria4116 Belgium3873 Bulgaria 940 Cyprus2962 Czech Rep.1934 Denmark4143 Estonia1645 Finland3448 France3427 Germany4541 Greece3000 Hungary1934 Iceland4595 Ireland4242 Italy3126 EUROPE 3406 Latvia1449 Lithuania1341 Luxembourg5621 Malta2524 Netherlands3418 Norway4865 Poland1796 Portugal2481 Romania1311 Slovakia1671 Slovenia2436 Spain3232 Sweden3793 Switzerland4224 United Kingdom4887

20. Total costs of mood disorders in European countries in 2010 (€PPP million, 2010): Austria 2253 Belgium 2679 Bulgaria 471 Cyprus 153 Czech Rep. 1341 Denmark 1446 Estonia 143 Finland 1183 France 13,892 Germany 24,561 Greece 2225 Hungary 1269 Iceland 89 Ireland 1155 Italy 12,392 EUROPE 113,405 Latvia 215 Lithuania 292 Luxembourg 179 Malta 68 Netherlands3597 Norway1479 Poland4489 Portugal1717 Romania1838 Slovakia 593 Slovenia 329 Spain9705 Sweden2268 Switzerland2144 United Kingdom 19,238

21. Cost per person and total costs by type of costs, mood disorders Cost per patient (€PPP, 2010) Direct healthcare costs 781 Direct non-medical costs 464 Indirect costs2161 Total3406 Total costs (€PPP million, 2010) Direct healthcare costs 26,016 Direct non-medical costs 15,437 Indirect costs 71,952 Total 113,405 Direct healthcare costs include all goods and services related to preven- tion, diagnosis and treatment, e.g. physician fees and hospitalization. Direct non-medical costs cover other goods and services related to the disorder, e.g. social services, special accomodation and informal care. Indirect costs cover work absences or retirement.

22. The most costly and prevalent brain disorders in Europe Total costs (€PPP million, 2010): 1. Mood disorders 113,405 2. Dementia 105,163 3. Psychotic disorders 93,927 4. Anxiety disorders 74,380 5. Addiction 65,684 6. Stroke 64,053 7. Mental Retardation 43,301 8. Sleep disorders 35,425 9. Traumatic brain injury 33,013 10. Personality disorder 27,345 __________________ Cardiovascular disease 182 Cancer 150 – 250 Prevalence: 1.Headache 152,812,362 2.Anxiety disorders 69,067,905 3. Sleep disorders 44,857,647 4. Mood disorders 33,290,962 5. Somatoform disorders 20,404,985 6. Addiction 15,538,043 7. Stroke 8,238,346 8. Dementia 6,341,179 9. Child/Adolescent dis. 5,932,112 10. Psychotic disorders 4,997,139

23. Recommendations: Increase support of research and encourage industry and investors to engage in research on depression Focus on the prevention of depression, and develop the best practice models in the organization of healthcare systems and social services Consider to include in the curricula and training elements regarding the costs and social burden of depression Monitor the impact of the prevention and treatment of depression on its costs.

24. Cost of depression in Europe EBC perspective Cyril Höschl