From environment to expenditure: Reassessing the economic burden of dementia

Background

Dementia is one of the most severe public health challenges in ageing societies, with a growing impact on health systems. Conventional cost-of-illness approaches often capture only a fraction of its true burden, focusing on healthcare expenditure while overlooking the broader environmental and social context in which people with dementia live. The aim of the study was to reassess the economic burden (EB) of dementia in Slovenia by integrating the role of environment, care, and social structures.

Methods

The EB of dementia was estimated for the period 2020–2024 using national routine health data. Direct costs included healthcare services (primary and secondary care, hospitalizations, medications). Indirect costs were calculated using the National Transfer Accounts (NTA) methodology, capturing lost productivity and the value of unpaid household work. The analysis also highlights the broader care environment, including informal caregiving and factors related to how care is organised.

Results

The estimated EB of dementia accounted for 0.3% of total health expenditure in Slovenia with the majority of costs related to medication, hospital care. The results show that the true burden is significantly underestimated, because some important costs are not fully included. If these costs were added to the overall burden, it would increase significantly, potentially reaching up to 1% of total health expenditure or even more.

Conclusions

Dementia is a medical and socio-economic issue influenced by the environment in which people live, receive care. Current estimates of EB fail to reflect its full societal impact. A shift towards a more comprehensive approach that considers social, environmental, and care-related factors is essential for understanding and addressing the true costs of dementia. Policies focusing on early detection, supportive care environments, and integrated health and social services are crucial for reducing long-term economic and social burden.

Key messages

• The EB of dementia extends far beyond healthcare expenditure and is influenced by the environment.

• Reassessing its EB through a socio-economic lens is essential for effective resource allocation.