As the world's population ages, Alzheimer's and dementia are set to create a staggering $14.5 trillion economic crisis, with informal caregiving placing an overwhelming burden on both high and low-income countries, demanding 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 Credit: Atthapon Raksthaput / Shutterstock
A recent study published in The Lancet Global Health has estimated the macroeconomic burden of Alzheimer’s disease and other dementias (ADODs) across 152 countries or territories.
The population is rapidly aging worldwide, with the proportion of people aged ≥ 65 projected to double by 2050. The United Nations General Assembly (UNGA) declared 2021-30 as the decade of healthy aging, fostering global, long-term collaborations to improve the lives of older individuals, their families, and the communities in which they live.
ADODs pose a severe threat to this initiative. These conditions are neurodegenerative disorders affecting older adults and inhibiting their mobility, cognitive capacity, daily life activities, and independence. Around 57 million individuals had ADODs in 2019, and it is estimated that by 2050, ADODs will affect 153 million persons.
Studies evaluating the economic effect of ADODs have mainly focused on illness costs. Alternative strategies consider the willingness-to-pay perspective. In contrast, macroeconomic models, such as the health-augmented macroeconomic model (HMM) and the economic projections for illness and cost of treatment (EPIC), assess the broader economic impact.
The study and findings
In the present study, researchers estimated the global macroeconomic burden of ADODs using an HMM. They used data from 152 countries/territories, including morbidity and mortality data, World Bank saving rates, and gross domestic product (GDP) projections. In the current HMM, ADODs affect the economy via reduced human or physical capital by four distinct pathways – 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 decrease ADOD morbidity and mortality and another scenario where ADODs were absent. The macroeconomic burden was calculated as the difference in projected GDP estimates between these two cases. Researchers also performed multiple sensitivity and uncertainty analyses were performed, accounting for variations in prevalence, morbidity, mortality, caregiving hours, currency units, and discount rates.
China, the United States, and Japan showed the most considerable economic burden of ADODs, amounting to 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. The per capita estimates ranged from INT$ 12 in Burundi to INT$ 15,049 in Japan.
Globally, the cumulative cost of ADODs was INT$14,513 billion between 2020 and 2050. This figure was equivalent to a per capita burden of INT$ 1,728 or 0.421% tax on global GDP. The total cost was INT$ 21,106 billion at a zero discount rate and INT$12,115 at 3% discount rate. Furthermore, the East Asia and Pacific region had the highest burden at INT$ 5,759 billion, followed by Europe and Central Asia (INT$ 4,530) and North America (INT$ 2,562).
Additionally, the burden of ADODs increased with income, and high-income countries had the highest burden at 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 distributed in proportion to disability-adjusted life years (DALYs) and population size. For instance, South Asia accounted for about one-fifth of DALYs in 2050 but only 3.88% of the global economic loss in 2020-50.
North America accounted 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. Moreover, the team examined the influence of varying durations of informal care and estimated the global costs 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. This modeling predicted a 28.6% reduction in the global burden to INT$ 10,358 billion. Notably, informal care constituted most of the global costs of ADODs across regions, with the highest proportion 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, accounting for the loss of labor and capital from ADODs' morbidity, mortality, and informal care. The health and economic burden were unequally distributed; the East Asia and Pacific region had the most significant economic burden.
The study’s limitations include reliance on assumptions for projections for prevalence, morbidity, mortality, labor participation, and GDP and the lack of specific country-level information on formal care and treatment costs. Additionally, the study covered 152 countries, or approximately 93% of the world’s population, leaving 7% unaccounted for.