The economic burden of neurological disorders in Europe – COIN-Eu: Study design and analytic framework

INTRODUCTION: Neurological disorders are a leading cause of disability, morbidity, and mortality globally, imposing a substantial and growing economic burden. In Europe, several factors including demographic aging and improved diagnostics have increased the prevalence of these conditions. Despite their significant societal impact, comprehensive and comparable estimates of the economic burden of neurological disorders across Europe remain limited. Existing studies are mostly outdated, disease-specific, or geographically narrow. The Cost Of Illness in Neurology in EUrope (COIN-Eu) study addresses this gap by developing a standardized framework to assess the disease- and country-specific economic burden of major neurological disorders across all 47 member countries of the European Academy of Neurology (EAN). METHODS: This burden-of-disease study employs a prevalence-based approach to estimate three key economic measures per disorder and country: (1) annual per-patient costs by cost type, (2) total annual costs on a national level, and (3) relative total costs as a percentage of GDP. The study includes twelve major neurological disorder groups affecting adults (≥ 20 years). Epidemiological data are primarily sourced from the Global Burden of Disease Study 2021, supplemented by systematic literature reviews where necessary. Cost data are extracted from systematic reviews of peer-reviewed publications and converted to 2019 Euros using standardized procedures. Data gaps are addressed through structured imputations based on income group stratification. Final estimates are validated by an expert panel from the EAN. RESULTS: The framework enables the generation of harmonized cost estimates across countries and disorders, accounting for direct and informal care costs and indirect costs. Expert review ensured plausibility and consistency of the results. CONCLUSION: The COIN-Eu study framework provides a comprehensive and transparent methodology to estimate the economic burden of neurological disorders in Europe. It facilitates evidence-based health policy planning, highlights data gaps, and supports future cross-national burden-of-disease assessments in neurology and beyond.