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Economic burden of sarcopenia-related disability in the elderly population: a study in Iran

BMC Research Notes volume 17, Article number: 319 (2024) Cite this article

Abstract

Objective

Sarcopenia is linked to escalating health costs, heightened risk of physical disability, diminished quality of life and an increased demand for care services. This study aimed to assess the economic impact of sarcopenia-related disability in Iran. A prevalence-based economic burden study was conducted utilizing the Population Attributable Risk (PAR) method, based on 2022 price index. Prevalence data for sarcopenia, categorized by gender and disease severity, were extracted from recent comprehensive studies. The relative risk of sarcopenia disability was determined from the most robust available evidence. Subsequently, direct medical costs, direct non-medical costs, and indirect costs for each individual with sarcopenia were computed and adjusted to 2022 values to estimate disability costs.

Results

Taking into account the prevalence of sarcopenia and the Iranian population across various age groups, 2,192,168 adults aged ≥ 60 years with sarcopenia in Iran were included. The total PAR of sarcopenia for men and women was estimated at 49% and 28%, respectively. The cumulative direct medical costs, direct non-medical costs, and indirect costs amounted to $215.1 million, $7.76 million, and $34.1 million, respectively. Additionally, the average total economic burden of sarcopenia-related disability in Iranian population aged ≥ 60 years was estimated at $257.1 million.

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Introduction

Sarcopenia is a common age-related disability characterized by the progressive loss of skeletal muscle mass and muscle function [1]. Evidence indicates a rapid increase in the prevalence of sarcopenia as the global population ages [1, 2]. According to the World Health Organization, it is projected that by 2050, there will be at least 2 billion people aged 65 or older. Starting from the age of 25, a gradual decline in the size and number of muscle fibers initiates, resulting in approximately a 30% loss of muscle mass by the age of 80 [3]. Based on the findings of epidemiological studies, it is estimated that sarcopenia occurs in 5–45% of the elderly population [4]. The results of evaluating the frequency of sarcopenia in Iran in 2011, based on the definition of the European Working Group on Sarcopenia in Older People (EWGSOP), in a sample of 300 people over the age of 55, revealed that 30% of men and 18% of women were sarcopenic [5, 6].

It should be noted that although sarcopenia primarily occurs in the elderly, there are also cases of this disease in young people [7]. Neuromuscular degeneration, alterations in muscle protein synthesis, fluctuations in hormonal levels and sensitivity, chronic inflammation, oxidative stress, as well as behavioral and lifestyle factors, are the primary causes of this disability [8, 9]. This condition results in an elevated risk of physical disability, falls, fractures, prolonged hospitalization, diminished quality of life and satisfaction, and ultimately mortality [8, 10, 11]. Additionally, it contributes to rising medical expenses and imposes significant financial burdens on both families and healthcare systems [2, 8, 12, 13].

The available information on the economic dimensions of sarcopenia and the economic burden of this disability is limited, with few studies in this regard [8, 10, 13, 14]. A study in the United States revealed that the total estimated cost of hospitalization for individuals with sarcopenia was 40.4 billion dollars, averaging 260 dollars per person [4]. Considering the aging population, as well as the health and economic side effects caused by the progression of the disease and the limitations of the financial resources of the healthcare system, the current study was conducted with the aim of estimating the economic burden of sarcopenia in Iran.

Main text

The prevalence-based economic burden study was conducted on adults aged 60 years and older with sarcopenia in Iran. The economic burden of sarcopenia-related disability was estimated using the Population Attributable Risk (PAR) method. The PAR was calculated based on the prevalence of sarcopenia and the relative risk of disability associated with the disease. Direct medical costs, direct non-medical costs, and indirect costs for individuals aged 60 and older were then extracted. Using the PAR values and the average cost of disability for this age group, the total economic burden of sarcopenia-related disability was estimated. The details of its steps are provided.

According to the Iranian Statistics Center, in 2022, 8.2% of the population belonged to this age group. Initially, the proportion of disability attributable to sarcopenia in the target population was calculated. Subsequently, by estimating the costs related to sarcopenia within this demographic group, the economic burden of disability attributable to sarcopenia was determined. To estimate the proportion of disability related to sarcopenia, the PAR was computed. PAR represents the proportion of disease incidence in the population (both exposed and non-exposed) that is attributable to exposure to the disease [15].

This index was calculated using the following formula:

$$PAR\, = \,\left( {P\left( {RR\, - \,1} \right)} \right)\,/\,\left( {1\, + \,P\,\left( {RR\, - \,1} \right)} \right)$$

P indicates the prevalence of sarcopenia, and RR (Relative Risk) represents the risk of disability due to sarcopenia in an individual. Data on the prevalence of sarcopenia in Iran, categorized by disease severity into moderate and severe cases, were extracted from the study by Shafiee et al. in 2019 [16]. Regarding the relative risk, reliable domestic studies were not available, so this value was obtained from the 3rd National Health and Nutrition Examination Survey [17].

To calculate the cost of disability, estimates were made for direct medical costs, direct non-medical costs, and indirect costs, which included productivity losses. In this context, the findings from two studies conducted in Iran by Hazrati et al. (2020) and Javan-Noughabi et al. (2020) [18, 19] regarding healthcare service costs for patients over 60 years of age were examined. Our primary criteria for selecting articles included an appropriate sample size for cost estimation and the homogeneity of the sample population in relation to the objectives of our study. Furthermore, Tehran, as the capital of Iran, has a diverse population representing various strata and ethnicities, which enhances the potential for generalizing the data to the entire country.

Hazrati et al.‘s study involving 1,288 elderly inpatients admitted to a hospital in Tehran, Iran, in 2017. This retrospective, bottom-up micro-costing analysis assessed the healthcare costs and its contributed factors for the elderly from the provider’s perspective. Additionally, Javan-Noughabi et al.‘s study was a cross-sectional study on 400 elderly patients admitted to two hospitals in Tehran in 2015, focusing on both medical and non-medical direct and indirect costs.

To adjust the values calculated in these studies to 2021 prices, the Health Price Index (HPI) published by the Iranian Statistics Center was utilized. Consequently, the average per capita medical expenses were computed. The estimation of direct non-medical costs and indirect costs was based on the findings from Javan-Noughabi et al.‘s study (2018) [18]. The values reported in this study, which were presented on an annual basis, were adjusted to 2022 prices using the Consumer Price Index (CPI) published by the Iranian Statistics Center. Subsequently, the economic burden of disability attributable to sarcopenia was calculated. In the analysis, cost variables were converted from the Iranian rial (IRR) to the US dollar using the weighted average of the different exchange rates in use in the country of USD/IRR = 252,422 in 2022 [20].

Results

In this study, the population of patients with sarcopenia comprised 2,192,168 individuals, including 1,147,791 men and 1,044,376 women. Table 1 displays the results of calculating the PAR of sarcopenia in Iran. The total prevalence rate of the disease in women and men was estimated at 30% and 32%, respectively. The Relative Risk (RR) of sarcopenia for women and men was 4.04 and 2.30, respectively. The total PAR for men and women was estimated at 49% and 28%, respectively.

Table 1 Population attributable risk of Sarcopenia in 2021
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Table 2 illustrates the estimated values of the average costs of sarcopenia in the elderly. The average direct medical, direct non-medical, and indirect costs of sarcopenia for an individual over 60 years were estimated at 251.33, 9.07, and $39.92 million, respectively. The total estimated cost was calculated at $300.32 million.

Table 2 Average cost of aging disability in 2021 (million US $)
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The distribution of different cost components, including direct medical, direct non-medical, and overall costs among various age groups of sarcopenia, is presented in Table 3. Within direct medical expenses, the highest and lowest shares were attributed to hoteling services (27%) and doctor’s visits (7.5%), respectively. Auxiliary equipment represented the highest cost among direct non-medical expenses. Additionally, the age group of 60 to 64 years had the largest expense share among different age groups.

Table 4 presents the results of calculations for the economic burden of disability arising from sarcopenia in Iran. The total direct medical cost, direct non-medical cost, and indirect cost of disability caused by sarcopenia were estimated to be 215.18, 7.76, and $34.18 million, respectively. The average economic burden of disability resulting from sarcopenia was estimated at $257.13 million. Figure 1 illustrates the distribution of different costs of sarcopenia by gender.

Table 3 Share of different sections in sarcopenia disability medical costs, direct non-medical costs, and age category in 2021
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Table 4 Economic burden of sarcopenia disability in 2021 (million US $)
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Fig. 1
figure 1

Economic burden of sarcopenia disability in 2021

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Discussion

Given the escalating trend of global aging, it is imperative to focus on age-related diseases such as sarcopenia. The purpose of this study was to estimate the economic burden of sarcopenia in Iran. According to the findings, sarcopenia accounted for the disability burden in 49% of men and 28% of women over 60 years of age. In the study by Goats et al., the economic burden of sarcopenia was higher in women than in men [14], which is in contrast to the findings of this study. One of the possible reasons for the difference in this finding could be the different proportion of men and women studied.

Among sarcopenia-related costs, direct medical costs comprised the major share, with hoteling costs being the largest component. Evidence shows that sarcopenia has a significant impact on healthcare costs, particularly direct costs [21]. Therefore, physical activity is suggested as an appropriate intervention to reduce this disability.

Direct non-medical costs were primarily associated with auxiliary equipment expenses. The distribution of medical expenses among the age groups of 60 to 64 years had the largest share. In the study by Goats et al., the average cost of sarcopenia was higher in older people [14].

Indirect costs, which included lost production and reduced productivity due to disability, were also calculated. Given that sarcopenia is most prevalent in old age and this age group often experiences a decline in productivity over time or may not work, the disease in these age groups incurs fewer indirect costs compared to other age groups.

The estimated economic burden of sarcopenia-related disability in Iran was $257.13 million, a considerable figure. This highlights that sarcopenia accounts for a significant portion of disability costs in the elderly population.

In fact, Iran’s GDP per capita in 2022 was $4668.5 based on current US$. Considering that the total economic burden has been calculated at $257.13, it will be almost 55,000 times Iran’s GDP per capita for that year [22].

In comparison, a study by Janssen et al. in the United States in 2004 found that the economic burden of sarcopenia disability accounted for only 1.5% of total US health expenditures in direct medical costs [23]. It should be noted that the calculated minimum and maximum economic burdens exhibit a significant difference from the average values. This discrepancy arises from the substantial variation among individuals in receiving medical services and experiencing lost productivity due to disability. Considering the significant economic burden imposed by sarcopenia in Iran, it seems that proactive intervention before the onset of disease consequences could lead to substantial savings in disease burden.

According to our knowledge, no comprehensive study has been conducted to estimate the total economic burden of sarcopenia. Previous economic studies on sarcopenia such as the studies by Janssen et al. (2004) in the USA [23], Sousa et al. (2016) in Portugal [24], Goates et al. (2019) in the USA [14], Mijnarends et al. (2016) in the Netherlands [11] and Pinedo-villanueva et al. (2018) in the UK [12] focused solely on the medical costs of the disease. Only the economic study of Steffl et al. (2017) [21] has investigated the direct and indirect costs of sarcopenia.

Limitations and future research perspectives

Due to the nature of the disease, which lacks specific consequences, it was very difficult to calculate the economic burden using conventional methods, and there was insufficient evidence in this regard. Overall, as evidence expands and access to necessary parameter values increases, it becomes possible to obtain a more comprehensive and accurate estimate of the economic burden attributed to sarcopenia.

Future research on sarcopenia should focus on conducting longitudinal studies to track disease progression and healthcare costs over time, especially in resource-limited settings like Iran. Investigating cost-effective prevention strategies, such as physical activity and nutrition programs, will be crucial. Additionally, expanding studies to include health-related quality of life assessments will provide a more comprehensive understanding of sarcopenia’s impact. Advanced modeling techniques like Markov models should be explored to better estimate long-term costs, and international collaborations are needed to standardize methods and improve cross-population insights.

Conclusion

The average economic burden of sarcopenia disability in Iran represents a substantial figure. This underscores the importance of timely intervention to prevent the consequences of the disease and conserve resources. This study marks one of the first economic evaluations of sarcopenia, conducted within the limitations of available evidence. Expanding and enhancing scientific evidence in this regard can contribute to achieving more comprehensive and accurate results in the future.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Abbreviations

RR:

Relative Risk

PAR:

Population Attributable Risk

HPI:

Health Price Index

CPI:

Consumer Price Index

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Acknowledgements

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Funding

There is no specific funding received for this study.

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Authors and Affiliations

  1. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, NO 10, Jalale-Al-Ahmad Ave, Chamran Highway, Tehran, 1411713137, Iran

    Ali Darvishi, Adeleh Nikkhah, Gita Shafiee & Ramin Heshmat

  2. Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Rajabali Daroudi

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  1. Ali Darvishi
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Contributions

A.D. , G.S.h. and R.H. developed the study’s design. R.D. and R.H. were in charge of data gathering. G.S.h. did data analyses and A.D. helped with interpreting the outcomes. A.N. wrote first draft of the manuscript. A.D., A.N. and R.H. proofread the first draft, and all the authors read and approved the final manuscript for submission.

Corresponding author

Correspondence to Ramin Heshmat.

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Ethics approval and consent to participate

This research was approved by the ethical committee of Tehran University of Medical Sciences (TUMS) by the code of IR.TUMS.EMRI.REC.1400.068. All the study protocols and methods were carried out in accordance with relevant guidelines and regulations. Informed consent was waived by the same ethics committee that approved the study (ethical committee of Tehran University of Medical Sciences).

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Competing interests

The authors declare no competing interests.

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Darvishi, A., Nikkhah, A., Shafiee, G. et al. Economic burden of sarcopenia-related disability in the elderly population: a study in Iran. BMC Res Notes 17, 319 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13104-024-06975-6

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BMC Research Notes

ISSN: 1756-0500

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