engleski

Socioeconomic significance of neurologic diagnosis and treatment (importance of the study of cost-benefit in neurology)

Scientific advances and technologic achievements in medici-ne over the last 3-4 decades have led to significant changes in neurology that have completely altered its role and scope of work. This relatively conservative, frequently expectative me-dical profession has turned into an active medical discipline with great possibilities of early diagnosis and efficient treat-ment which is especially successful in early disease stages. At the same time, the socioeconomic burden of neurologic disea-ses has become ever more evident, not only due to the reduced quality of life and premature mortality, but also because of decreased working capacity and costs of care and treatment of these patients. The role of neurology in modern society has gained in importance by recognizing the brain and nervous system as the seat of the man's personality and spiritual life, where many mental disorders and socially unacceptable behavioral patterns originate from. Current statistics in developed countries indicates that more than more fourth of all patients require neurologic treatment or neurologic consultation. Coordination of the results of basic neuroscience with clinical and neuroepidemiologic research have revealed some new concepts on the causes and risk factors for a number of neurologic diseases or syndromes, allowing not only rational therapy, but also their successful prevention, e.g., stroke, especially in collaboration with primary practitioners and other specialists. Almost inconceivable diagnosis and tre-atmenf results have been achieved in almost all fields of neuro-logy: cerebrovascular disease, epilepsy, movement disorders (extrapyramidal diseases), to mention only some of them. Current neurosurgery is part of successful neurologic treat-ment, while the combined use of update scientific concepts and technologies opens new perspectives in neurorehabilita-tion and restitution of nervous functions, ensuring a higher quality of life for neurologic patients and their surrounding. Further advances in the field of prevention and treatment of neurologic diseases, especially of some that have long been considered fateful (e.g., dementia and brain aging) are expected. In Croatia, the described progress of neurology in the rich countries of America and Europe has been paralleled by an increase in the number of institutions specialized in neurology and of specialist neurologists very actively engaged in the newly formed, specialized fields of the profession. These processes have generally led to an increase in the cost of neurologic dia-gnosis and treatment, justifying the question of cost-benefit of some adopted diagnosis and treatment procedures to be po-sed. Although Croatian neurologists were among the first to investigate the economic aspects of the efficacy of the treat-ment for neurologic diseases, either in the form of rational ser-vice organization or trying to create models of specific algori-thms for rational diagnosis and treatment of particular neuro-logic diseases and syndromes, these studies have occasionally been erroneously considered less "scientific" or have been left to non-neurologists. Only the neurologic profession can pose right questions and provide right answers, while an appropria-te scientific methodology could also ensure scientifically rele-vant results of such, by their nature neuroepidemiologic stu-dies, which would substantially contribute to the knowledge about the neurologic disease investigated. Only 94 papers are found in the Medline database for the 1992-1995 period on the following discriminators: cost-benefit analysis, neurology, brain diseases, cerebrovascular disorders, epilepsy, and neuromuscular disease, suggesting that the stu-dy of these issues has begun quite late. Whereas in the USA, health care planners occasionally use to point to the need of reduction of the cost-producing specialists and increase in the number of primary contact physicians, there are ever louder appeals advocating the need of proper, continuous education of neurologists and of neurologic training of non-neurologists, in view of the specific approach to the neurologic patient, em-phasizing the role of appropriate use of new technologies. It is our pleasure, therefore, that at the next World Congress of Neurology, to be held in Buenos Aires, September 1997, under the auspices and in collaboration with the World Health Organization, we are in charge of the topic of Neurology and public health. Economic consequences of the costs of treatment and diagnosis, which is of utmost importance not only for less developed, but also for the richest countries, of the world.

cost-benefit; neurology; diagnosis; treatment

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