Cost of care for persons with dementia: using a discrete-time Markov chain approach with administrative and clinical data from the dementia service Centres in Austria

Alexander Braun,Paulina Kurzmann,Margit Höfler,Stefanie Auer,Gottfried Haber

doi:10.1186/s13561-020-00285-w

Abstract

BackgroundThere is growing evidence that the cost for dementia care will increase rapidly in the coming years. Therefore, the objective of this paper was to determine the economic impact of treating clients with dementia in outpatient Dementia Service Centres (DSCs) and simulate the cost progression with real clinical and cost data.MethodsTo estimate the cost for dementia care, real administrative and clinical data from 1341 clients of the DSCs were used to approximate the total cost of non-pharmaceutical treatment and simulate the cost progression with a discrete-time Markov chain (DTMC) model. The economic simulation model takes severity and progression of dementia into account to display the cost development over a period of up to ten years.ResultsBased on the administrative data, the total cost for treating these 1341 clients of the DSCs came to 67,294,910 EUR in the first year. From these costs, 74% occurred as indirect costs. Within a five-year period, these costs will increase by 7.1-fold (16.2-fold over 10 years). Further, the DTMC shows that the greatest share of the cost increase derives from the sharp increase of people with severe dementia and that the cost of severe dementia prevails the cost in later periods.ConclusionThe DTMC model has shown that the cost increase of dementia care is mostly driven by the indirect cost and the increase of severity of dementia within any given year. The DTMC reveals also that the cost for mild dementia will decrease steadily over the time period of the simulation, whereas the cost for severe dementia increases sharply after running the simulation for 3 years.

Highlights

In Austria, 145,431 persons are currently living with dementia [1]
Our analysis focuses on the following issues: (1) raising the stage specific cost of care in a sample of home dwelling persons living with dementia, (2) the progression of dementia as observed under the influence of longitudinal treatment with non-pharmacological methods, and (3) using the clinical progression as basis for a Markovbased simulation framework to simulate the cost development of Dementia Service Centres (DSC) services in Austria
Cost assessment Direct cost As direct costs of treatment, we identified two main cost sources: (1) the treatment costs that are incurred from the DSC itself, and (2) the costs that are reallocated by statutory long-term care benefit (Bundespflegegeld) from the government

Summary

Introduction

In Austria, 145,431 persons are currently living with dementia [1]. The costs of illness for dementia in Austria were estimated in the year 2009 at 2.9bn EUR [3, 4]. There is overwhelming evidence that in ageing societies the cost for dementia care will increase rapidly [4,5,6,7,8]. Especially in German speaking countries, little information about stage-specific cost of care is currently available. Even less information on the cost of community care settings is available and none of the studies take into account the fact of the progressive nature of dementia [9, 10]. There is growing evidence that the cost for dementia care will increase rapidly in the coming years. The objective of this paper was to determine the economic impact of treating clients with dementia in outpatient Dementia Service Centres (DSCs) and simulate the cost progression with real clinical and cost data

Objectives

Methods

Results

Discussion

Conclusion