As the world’s population ages, Alzheimer’s disease and dementia will trigger a staggering $14.5 trillion economic crisis, with informal caregiving placing an overwhelming burden on both high- and low-income countries and requiring urgent global policy action.
Study: The global macroeconomic burden of Alzheimer’s disease and other dementias: estimates and projections for 152 countries or territories. Image credits: Atthapon Raksthaput / Shutterstock
A recent study published in The Lancet Global Health estimated the macroeconomic burden of Alzheimer’s disease and other dementias (ADODs) in 152 countries or territories.
The population is aging rapidly worldwide, with the share of people aged ≥ 65 years expected to double by 2050. The United Nations General Assembly (UNGA) has declared 2021-2030 the Decade of Healthy Aging, promoting global, long-term collaborations to improve the situation. lives of older individuals, their families and the communities in which they live.
ADODs pose a serious threat to this initiative. These conditions are neurodegenerative disorders that affect older adults and impair their mobility, cognitive capacity, daily activities, and independence. In 2019, approximately 57 million people had ADODs, and it is estimated that ADODs will affect 153 million people by 2050.
Studies evaluating the economic impact of ADODs have mainly focused on health costs. Alternative strategies take into account the willingness to pay perspective. In contrast, macroeconomic models, such as the Healthcare-Based Macroeconomic Model (HMM) and the Economic Projections for Disease and Treatment Costs (EPIC), assess the broader economic impact.
The research and findings
In the current study, researchers estimate the global macroeconomic burden of ADODs using an HMM. They used data from 152 countries/territories, including morbidity and mortality data, the World Bank savings rate, and gross domestic product (GDP) projections. In today’s HMM, ADODs impact the economy through reduced human or physical capital through four different routes: 1) morbidity, 2) mortality, 3) formal care and treatment costs, and 4) informal care.
GDP was compared from 2020 to 2050 in a scenario with no interventions to reduce ADOD morbidity and mortality and another scenario in which ADODs were absent. The macroeconomic burden was calculated as the difference in the expected GDP estimates between these two cases. Researchers also conducted multiple sensitivity and uncertainty analyses, taking into account variations in prevalence, morbidity, mortality, caregiving hours, currency units, and discount rates.
China, the United States and Japan showed the largest economic burden of ADODs, at 2,961 billion international dollars (INT$). The United States and Japan followed China with a burden of INT$2.331 billion and INT$1.758 billion respectively. The cost of ADODs ranged from 0.059% of GDP for Guinea-Bissau to 1.463% for Japan. Per capita estimates ranged from INT$12 in Burundi to INT$15,049 in Japan.
Globally, the cumulative cost of ADODs between 2020 and 2050 was INT$14,513 billion. This figure corresponded to a per capita burden of INT$1,728 or 0.421% tax on global GDP. The total cost was INT$21,106 billion at a zero discount rate and INT$12,115 at a 3% discount rate. Moreover, the East Asia and Pacific region had the highest burden at INT$5,759 billion, followed by Europe and Central Asia (INT$4,530) and North America (INT$2,562).
Furthermore, the burden of ADODs increased with income, and high-income countries had the highest burdens: INT$8,989 billion and INT$7,514 per capita. Conversely, ADODs cost INT$51 billion and INT$70 per capita in low-income countries. The economic burden was not proportionally distributed by disability-adjusted life years (DALYs) and population size. For example, South Asia was responsible for about a fifth of DALYs in 2050, but only 3.88% of global economic loss in 2020-50.
North America was responsible for 4.6% of DALYs in 2050, but 17.6% of global economic loss in 2020-50. By 2050, middle and low-income countries will contribute 74.1% of DALYs, as the share of DALYs in high-income countries decreases. Additionally, the team examined the impact of different durations of informal care and estimated the global cost to be between INT$11.986 billion and INT$19.554 billion.
Additionally, the team modeled a hypothetical 40% decrease in ADODs, given the Lancet Commission report that 40% of dementias could potentially be delayed or prevented. These models projected a 28.6% reduction in global burdens to INT$10,358 billion. Notably, informal care accounts for the largest share of the global costs of ADODs across all regions, with the highest share in lower-income countries. Formal care and treatment costs were higher in high-income countries.
Conclusions
Together, the study estimated the global macroeconomic burden of ADODs at INT$14,513 billion in 2020-50, which takes into account the loss of labor and capital due to the morbidity, mortality and informal care of ADODs. The health and economic burdens were unevenly distributed; the East Asia and Pacific region had the greatest economic burden.
The study’s limitations include reliance on assumptions for projections for prevalence, morbidity, mortality, labor force participation, and GDP and the lack of country-level specific information on formal care and treatment costs. Additionally, the study included 152 countries, or approximately 93% of the world’s population, leaving 7% unaccounted for.