title: The impact of acquired brain damage in terms of epidemiology, economics and loss in quality of life.
abstract: BACKGROUND
  Patients with acquired brain damage (ABD) have suffered a brain lesion that interrupts vital development in the physical, psychological and social spheres. Stroke and traumatic brain injury (TBI) are the two main causes. The objectives of this study were to estimate the incidence and prevalence of ABD in the population of the Basque Country and Navarre in 2008, to calculate the associated cost of the care required and finally to assess the loss in health-related quality of life.
  
  
  METHODS
  On the one hand, a cross-sectional survey was carried out, in order to estimate the incidence of ABD and its consequences in terms of costs and loss in quality of life from the evolution of a sample of patients diagnosed with stroke and TBI. On the other hand, a discrete event simulation model was built that enabled the prevalence of ABD to be estimated. Finally, a calculation was made of the formal and informal costs of ABD in the population of the Basque Country and Navarre (2,750,000 people).
  
  
  RESULTS
  The cross-sectional study showed that the incidences of ABD caused by stroke and TBI were 61.8 and 12.5 cases per 100,000 per year respectively, while the overall prevalence was 657 cases per 100,000 people. The SF-36 physical and mental component scores were 28.9 and 44.5 respectively. The total economic burden was calculated to be 382.14 million euro per year, distributed between 215.27 and 166.87 of formal and informal burden respectively. The average cost per individual was 21,040 € per year.
  
  
  CONCLUSIONS
  The main conclusion of this study is that ABD has a high impact in both epidemiological and economic terms as well as loss in quality of life. The overall prevalence obtained is equivalent to 0.7% of the total population. The substantial economic burden is distributed nearly evenly between formal and informal costs. Specifically, it was found that the physical dimensions of quality of life are the most severely affected. The prevalence-based approach showed adequate to estimate the population impact of ABD and the resources needed to compensate the disability.
authors.affiliation: Clinical Management Service, Alto Deba Hospital, Mondragon, Spain. javier.marmedina@osakidetza.net
authors.forename: Javier
authors.initials: J
authors.lastname: Mar
authors.forename: Arantzazu
authors.initials: A
authors.lastname: Arrospide
authors.forename: José María
authors.initials: JM
authors.lastname: Begiristain
authors.forename: Isabel
authors.initials: I
authors.lastname: Larrañaga
authors.forename: Elena
authors.initials: E
authors.lastname: Elosegui
authors.forename: Juan
authors.initials: J
authors.lastname: Oliva-Moreno
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D001930:Brain Injuries / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011788:Quality of Life; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires