Brenda Gannon

The size, burden and cost of disorders of the brain in the UK

Aim: The aim of this paper is to increase awareness of the prevalence and cost of psychiatric and neurological disorders (brain disorders) in the UK. Method: UK data for 18 brain disorders were extracted from a systematic review of European epidemiological data and prevalence rates and the costs of each disorder were summarized (2010 values). Results: There were approximately 45 million cases of brain disorders in the UK, with a cost of €134 billion per annum. The most prevalent were headache, anxiety disorders, sleep disorders, mood disorders and somatoform disorders. However, the five most costly disorders (€ million) were: dementia: €22,164; psychotic disorders: €16,717; mood disorders: €19,238; addiction: €11,719; anxiety disorders: €11,687. Apart from psychosis, these five disorders ranked amongst those with the lowest direct medical expenditure per subject (<€3000). The approximate breakdown of costs was: 50% indirect costs, 25% direct non-medical and 25% direct healthcare costs. Discussion: The prevalence and cost of UK brain disorders is likely to increase given the ageing population. Translational neurosciences research has the potential to develop more effective treatments but is underfunded. Addressing the clinical and economic challenges posed by brain disorders requires a coordinated effort at an EU and national level to transform the current scientific, healthcare and educational agenda.

Application of Resource Utilization in Dementia (RUD) instrument in a global setting

The Resource Utilization in Dementia (RUD) questionnaire is the most widely used instrument for resource use data collection in dementia, enabling comparison of costs of care across countries with differing health care provisions. Recent feedback from payers questioned its face validity given that health care provisions have changed since the initial development of the RUD in 1998. The aim of this study was to update the RUD to improve its face validity in Alzheimers disease (AD) clinical research and its utility for health care resource allocation.

Estimating the extra cost of living for people with disabilities

Addressing the extra economic costs of disability is a logical step towards alleviating elements of social exclusion for people with disabilities. This study estimates the long-run economic cost of disability in Ireland in terms of the additional spending needs that arise due to disability. It defines and estimates models of the private costs borne by families with individuals who have a disability in Ireland when compared with the wider population, both in general and by severity of disability. Our modelling framework is based on the standard of living approach to estimating the cost of disability. We extend on previous research by applying panel ordered probit models to living in Ireland survey data 1995-2001 in order to control for the effects of previous disability and income and correlated unobserved heterogeneity. The approach allows us to quantify, for the first time, the additional long-run economic costs of living associated with disability. Our findings suggest that the extra economic cost of disability in Ireland is large and varies by severity of disability, with important implications for measures of poverty.

Age and disability: Explaining the wage differential

This paper estimates the level of explained and unexplained factors that contribute to the wage gap between workers with and without disabilities, providing benchmark estimates for Ireland. It separates out the confounding impact of productivity differences between disabled and non-disabled, by comparing wage differentials across three groups, disabled with limitations, disabled without limitations and non-disabled. Furthermore, data are analysed for the years 1995-2001 and two sub-samples pre and post 1998 allow us to decompose wage differentials before and after the Employment Equality Act 1998. Results are comparable to those of the UK and the unexplained component (upper bound of discrimination) is lower once we control for productivity differences. The lower bound level depends on the contribution of unobserved effects and the validity of the selection component in the decomposition model.

Eliciting preferences for resource allocation in mental health care in Ireland

The proportion of total health care expenditure devoted to mental health care in Ireland, at just below 7%, is low relative to other countries. There have been few studies that have examined the relationship between public preferences for different kinds of health care expenditure and priority setting as undertaken by policy-makers and governments. This paper examines citizens rankings and willingness to pay for a community-based mental health care programme in Ireland relative to two other programmes: cancer and elderly care. Respondents rank cancer as the most important programme, followed by elderly care and then mental health care. The contingent valuation survey demonstrated that people are willing to make significant tax contributions to new community-based services for people with mental health problems, counteracting the view sometimes expressed that people do not care at all about mental health care provision. However, the survey also found that people tend to value additional spending on mental health care lower than cancer and elderly care programmes.

Total factor productivity growth of hospitals in Ireland: A nonparametric approach

This article analyses the development of productivity growth and efficiency in the production of hospital care in Ireland from 1995 to 1998. Using output measures of treated cases adjusted for casemix, we apply Malmquist Productivity Indices to analyse changes in efficiency over time. This approach provides information on the types of hospitals that have increased or decreased efficiency during each time frame and the type of inefficiency involved – pure technical, scale or technological. Our results show that on average between 1995 and 1998, both technological and efficiency changes contribute to higher levels of productivity in larger hospitals, but lead to lower levels of productivity in smaller hospitals. However, the contribution of these components of productivity varies over time and technological improvements play a more important role in increasing the productivity of larger hospitals.

The Cost of Chronic Pain: An Analysis of a Regional Pain Management Service in Ireland

OBJECTIVE The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. SETTING A tertiary pain management clinic serving a mixed urban and rural area in the West of Ireland. DESIGN Data were collected from 100 patients using the Client Services Receipt Inventory and focused on direct and indirect costs of chronic pain. METHODS Patients were questioned about health service utilization, payment methods, and relevant sociodemographics. Unit costs were multiplied by resource use data to obtain full costs. Cost drivers were then estimated. RESULTS Our study showed a cost per patient of US

The influence of economic incentives on reported disability status

24,043 over a 12-month period. Over half of this was attributable to wage replacement costs and lost productivity in those unable to work because of pain. Hospital stays and outpatient hospital services were the main drivers for health care utilization costs, together accounting for 63% of the direct medical costs per study participant attending the pain clinic. CONCLUSION The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden.

Part-time work and Health among Older Workers in Ireland and Britain

Self-reported disability status is often relied upon in labour force participation models, but this may be reported with error for economic or psychological reasons and can lead to a bias in the effect of disability on participation. In this paper, we explore the possibility that reported limitations in daily activities are mis-reported, in particular for those who define their labour force status as disabled/ill, and assess if economic incentives influence this group to mis-report. The main questions we wish to address therefore are: (1) was there state-dependent reporting error and did economic incentives play a role, and (2) did this change over the years 1995-2001? Using a generalised ordered response model, we compute cleansed measures of disability that correspond to predicted responses individuals would have made if employed. Unobserved differences between the employed and non-employed may exist; therefore, we control for this via correlated random effects. The results indicate that the disabled/ill group did over-report and the difference between actual and predicted probabilities only marginally changed between 1995 and 2001. The extent of this measurement error is lower once we control for unobserved heterogeneity.

The welfare implications of disability for older people in Ireland.

Part-Time (PT) work is viewed as a viable option for people who wish to have a gradual transition to retirement. From a policy viewpoint, this may help to alleviate some labour supply shortages and fiscal pressures, especially in the context of the ageing population. Factors such as health or pension provision may influence a persons decision to work PT. This article considers the impact of health on the work decision of people aged 50 and over in the UK and Ireland. Methodological issues are discussed and the impact of unobserved individual effects is estimated using the Mundlak (1978) estimator applied to the multinomial probit model. We find that health problems increase the probability of retirement for this age group in both countries. In Britain, those with health problems are less likely to work full time and more likely to work PT, however in Ireland, health problems appear to have no effect on the probability of PT work. This article discusses the potential reasons for these impacts and current policies on PT work.