This study found an economic burden of dementia for those 50 years and above amounting to a total of 19.161 billion USD in the best-case scenario and 22.704 billion USD in the worst-case scenario for the year 2020. It is important to note that these costs are estimates rather than precise calculations. Using a comparable methodology [7, 9–11], the cost estimates for the year 2009 in the Arab region were 4.212 billion USD for the best-case scenario and 6.707 billion USD for the worst-case scenario . This significant increase in the economic burden of dementia is due to several reasons. Demographic changes have occurred where, for example, the total population above the age of 60 in 2020 was about 2.5 times the population above 60 in 2009 (due to ageing and increases in total population). The correlation between GDP per capita and direct cost also changed from 43.6–86.0% . Lastly, we also found an increase in the average GDP per capita estimate for the region when calculated so that the average is weighted according to the population of each country.
Even though the World Alzheimer Report 2015 had estimated the cost of dementia at 16.7 billion USD for the Middle East and North Africa, a different methodology was applied . This cost had also included Turkey and Iran, where both of these countries had populations estimated at around 78.5 million each . Also, the report had not provided country-specific estimates. This is important due to variations in country income groups across the region. Countries from the Gulf are considered high-income countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) while the other Arab countries belong to either the middle-income or low-income groups .
For 2020, the international cost of dementia had been estimated at 1.71 trillion USD . Thus, the costs in the Arab region (for those 50 and above) are around 1.1% (in the best-case scenario) to 1.3% (in the worst-case scenario) of that, and this is reflective of individuals with dementia in the region also constituting about 3–4% of all those with dementia internationally . Yet, compared to other types of health conditions, the economic burden of dementia is significant. We extrapolated data to compare the direct cost of dementia to the direct cost of diabetes in the region . Our findings showed that the direct cost of dementia in the Arab region is estimated at around 0.8–0.9 times the direct cost of diabetes.
One of the limitations of this study was considering global data about prevalence rate to be the same across all of the Arab countries. We had found four studies from the Arab world estimating the prevalence of dementia from community samples (in Egypt, Iraq and Lebanon) where data had been collected after 2010. In Egypt, a study from one city found 4% among those above 60, while another from a governorate found 5% for the same age group [21, 22]. In Iraq, a study from Baghdad estimated the prevalence rate in the community at 5% above the age of 60 . In Lebanon, a population-based study from two governorates had a prevalence rate of 7.5% for the age group above 65 years . Hence, there is a scarcity of research about this estimate from the Arab region and the results of the community studies often do not account for those in nursing homes yet were mostly within the range of global estimates. The scarcity of research about dementia has been indicated in a study where El-Masri and colleagues collected data from PubMed about the number of studies related to neurodegenerative diseases between 2005 and 2019. The results showed that Arab countries had contributed to only about 0.8% of all publications worldwide related to neurodegenerative disorders (1,311 studies from a total of 169,330) . Research centers in the Arab world have recently started increasing their research productivity on dementia . Some of the challenges that the Arab region has encountered include less funding compared to other types of diseases (such as cancer, cardiovascular diseases and diabetes) and scarcity of specialized institutions . Other challenges relate to the healthcare research infrastructure in the Arab region overall, economic or political instability in some of the countries, potential bureaucratic or regulatory hurdles, and a lack of standardizing neuro-psychometric research instruments in the region [8, 26].
Our research also has similar limitations implied in previous international studies that have followed this methodology [7, 9, 10]. First, the association between GDP per capita and healthcare expenditure is assumed to also apply to expenditure for the condition of dementia in specific. Second, this correlation is mostly based on studies from developed countries. It is hypothesized that the percentage of GDP per capita expenditure for the condition increases with an increase in a country's income. However, this is not applied here. Also, even though this is an economic evaluation, there is no indication about the quality of care provided and the indirect costs resulting from pre-mature retirement or mortality. The estimated number of hours that caregivers have spent in care is also mostly from Western studies, even though there is evidence that some Asian cultures (India, Korea) have similar estimates. Lastly, the hourly wage of a retired individual was considered to be equivalent to that of a working-age individual. Although this is also considered in similar types of research, this could have created a minor overestimate of indirect costs.
We found that indirect costs account for almost 20% of the total economic burden. In the Arab world, due to societal norms, the family members are mostly responsible for caring for patients with dementia. Placing a person with dementia in a care home is still considered taboo, and in some cases, the stigma exists even if the patient requires complete nursing care . Some countries in the region with a high burden have introduced homecare where the caregiver is supported with specialized social service and healthcare teams to provide better quality care for patients .