Costs for Neurologic Diseases Soar

Pauline Anderson

April 13, 2017

As more Americans live longer and survive heart disease, cancer, and other chronic conditions, the number with neurologic disorders, which disproportionately affect the elderly, is increasing dramatically.

As of 2011, almost 100 million Americans had at least 1 of the more than 1000 neurologic diseases, with a huge impact on the healthcare system.

"Society as a whole is kind of asleep at the switch and doesn't fully recognize that this is a problem," Clifton L. Gooch, MD, professor and chair, Department of Neurology, University of South Florida Morsani College of Medicine, Tampa, told Medscape Medical News.

"We really need to make a serious investment in research aimed at finding treatments and cures well beyond current levels."

Dr Gooch was lead author of a summary report and "call to action" on the burden of neurologic disease in the United States published online in Annals of Neurology.

Dr Gooch and colleagues looked at the economic impact of the nine most prevalent and costly neurologic disorders. From the most to least costly in terms of direct and indirect costs (annually in billions of 2014 dollars), these are:

 

  • Alzheimer's and other dementias ($243);

  • Chronic low back pain ($177);

  • Stroke ($110);

  • Traumatic brain injury ($86);

  • Migraine headache ($78);

  • Epilepsy ($37);

  • Multiple sclerosis ($25);

  • Spinal cord injury ($19); and

  • Parkinson's disease ($15).

"When I started this project, I didn't anticipate that we would get to the $800 billion total cost that we found when we finally did the number crunching," said Dr Gooch.

"As a yardstick for comparison, the entire US military budget in 2016 was $598 billion, and that's the world's largest military budget," said Dr Gooch.

This cost will increase further as the number of elderly nearly doubles over the coming years.

"When you talk about doubling the population and you talk about a cost already of about $800 billion, you're now talking about 1.6 trillion dollars," said Dr Gooch.

"Over the coming 20 or 30 years, we will get into a situation where the costs are maybe three or four times the military budget."  

The escalating costs could "utterly destabilize the healthcare system" and "begin to have serious impacts on the entire economy," said Dr Gooch.

It's reported that Alzheimer's disease (AD) alone will bankrupt the country, said Dr Gooch.

The costs include more than just drugs. "When people think of costs of disease, they usually just think about how much their medicine costs or how much it costs to go the doctor or hospital, or to get an MRI," said Dr Gooch.

But that's only part of the cost, he said. "Neurological diseases, more so than for most any other category of disease, are primary drivers of disability and, in many cases, very severe disability."

This is particularly true for advancing Alzheimer's disease or for severe strokes, said Dr Gooch. "These diseases often render patients completely disabled and totally dependent on long-term care."

Indirect costs also encompass lost wages and productivity, which are particularly relevant for neurologic diseases, for example, migraine headaches, that affect relatively young patients.

Although the growing costs of neurologic and other diseases were a major impetus for the implementation of the Affordable Care Act, it's not clear that the proposed measure of this program will be sufficient to meet "the daunting fiscal challenges of the near future," the report authors write.

A concrete strategy "is urgently needed to reduce the burden of neurological diseases," they said.

Declare War

Dr Gooch and his colleagues want to declare war on neurologic diseases just as a similar fight was waged — and in large part won — on cancer and heart disease.

In the 30 years after the National Cancer Act was passed in 1971, "massive amounts of money were spent in cancer research," said Dr Gooch. "We haven't eliminated all cancers, but we have made tremendous strides."

The story is similar with heart disease, he said.

"The life expectancy in the US increased from 68 years in 1970 to about 80 years in 2017, which is the greatest increase by far in the history of the world. Two of the major drivers of that increase have been decreases in mortality from heart disease and cancer."

Meanwhile, there has not been a similar level of investment in neurologic diseases, said Dr Gooch.

"We don't necessarily need to find a cure for everything, which is a high bar, but if we can even find treatments that will simply slow the disease or delay its onset, that could have tremendous benefits."

For example, said Dr Gooch, if researchers found a treatment that delayed the onset of AD by 10 years, that would push the disease beyond the lifespan of most susceptible people.

"If we are aggressive enough about funding research into these disorders, I'm confident that we can find at least some disease-modifying or delaying treatment that could make a huge impact not only on our patients but also on the cost of these disorders."

Dr Gooch noted that the federal government funds most basic science research. "They are the only ones who have the resources to be able to adequately fund this research."

He sees this new paper as a spark to help raise awareness about the need for research funding.

"What Congress doesn't understand yet, and hopefully this will help to educate them, is how much it really costs now and what the cost is going to be in future if we don't do something about it," said Dr Gooch.

"Obviously this paper alone is not going to ignite the rocket boosters enough to solve the whole problem, but I hope we can get the ball rolling."

The authors have disclosed no relevant financial relationships.

Ann Neurol. Published online February 15, 2017. Abstract

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