Читать книгу Neurology - Charles H. Clarke - Страница 22

The principal duty of a clinician is to provide individual care. However, doctors are now rightly involved in economic considerations. In any study of cost, analysis is of signal importance. Who was the study for, and who did it? The cost and burden for an individual have different parameters when compared with the effect on families, on health services and on society. Many studies are carried out from the point of view of society, with costs estimated in terms of lost employment, lost productivity and premature death, rather from the perspective of a patient, or their family.

 Direct costs mean any resource used – medical costs of primary care, out‐patient and in‐patient investigation, drugs, residential and community care, training and rehabilitation.

 Indirect costs are from lost economic production. They include premature mortality, dependency, unemployment and underemployment. The ‘human capital’ approach ascribes a monetary value to a person in terms of their potential productivity.

Table 1.3 DALYs (Disability‐Adjusted Life Year) for neurological and psychiatric conditions.

Source: Modified from Olesen and Leonardi 2003.

Condition	DALYs × 10
Europe	Wealthy countries a	India	Sub‐Saharan Africa	World
Neurological and psychiatric conditions (all)b	53 009	24 682	23 949	15 788	165 082
Cerebrovascular disease	10 316	5166	5223	5487	45 770
Unipolar depression	4091	6721	10 064	6193	60 166
Bipolar disease	1541	1673	2867	1,785	16 722
Schizophrenia	1609	2151	2041	611	14 614
Epilepsy	633	427	848	526	4712
Alcoholism	4435	4611	1113	2387	18,973
Dementia	4531	3286	1192	453	10 135
Parkinson’s disease	428	523	167	63	1278
Multiple sclerosis	303	222	253	140	1569

^a Established market economies.

^b This category excludes cerebrovascular disease.

Disability‐adjusted life year is an indicator of the time lived with a disability and the time lost due to premature mortality. Reproduced with permission from the World Health Organization 1996b. The figures for Europe were separately calculated (Olesen and Leonardi 2003).

Ethical and personal issues are intertwined with cost‐effectiveness. Therapies that are neither cost‐effective from the epidemiological nor from point of view of society can help an individual – such as the belief in homeopathic therapy, or travel to a centre for healing. Societal and evidence‐based, clinical perspectives clash.

Social policy can greatly lessen the individual burden, for example by financial benefits and social support. It must be stressed that in the majority of countries, even those who pride themselves on wealth and power, there is either no or minimal support for those who are ill, either acutely or chronically.