Abstract
ObjectivesTo examine the costs of caring for community-dwelling patients with Alzheimer’s disease (AD) dementia in relation to the time to institutionalisation.MethodsGERAS was a prospective, non-interventional cohort study in community-dwelling patients with AD dementia and their caregivers in three European countries. Using identified factors associated with time to institutionalisation, models were developed to estimate the time to institutionalisation for all patients. Estimates of monthly total societal costs, patient healthcare costs and total patient costs (healthcare and social care together) prior to institutionalisation were developed as a function of the time to institutionalisation.ResultsOf the 1495 patients assessed at baseline, 307 (20.5%) were institutionalised over 36 months. Disease severity at baseline [based on Mini-Mental State Examination (MMSE) scores] was associated with risk of being institutionalised during follow up (p < 0.001). Having a non-spousal informal caregiver was associated with a faster time to institutionalisation (944 fewer days versus having a spousal caregiver), as was each one-point worsening in baseline score of MMSE, instrumental activities of daily living and behavioural disturbance (67, 50 and 30 fewer days, respectively). Total societal costs, total patient costs and, to a lesser extent, patient healthcare-only costs were associated with time to institutionalisation. In the 5 years pre-institutionalisation, monthly total societal costs increased by more than £1000 (€1166 equivalent for 2010) from £1900 to £3160 and monthly total patient costs almost doubled from £770 to £1529.ConclusionsTotal societal costs and total patient costs rise steeply as community-dwelling patients with AD dementia approach institutionalisation.
Highlights
Cost-of-illness (COI) studies have shown that the two most important cost drivers in dementia care from a societal perspective are the costs of institutional care and the costs of informal care for patients who are cared for at home [1, 2].Time to institutionalisation is often used as an outcome measure in Alzheimer’s disease (AD) dementia trials
The difference between total societal costs and total patient costs is likely a result of caregiver informal care costs, which are the main component of societal costs [12] and remain so irrespective of differences in the unit costs used to calculate the different components of informal care costs, such as country-specific wages [12, 20, 22]
As we did not estimate costs after institutionalisation, we could not compare costs before and after institutionalisation. This proof-of-concept model demonstrates that total societal costs and total patient costs rise steeply as communitydwelling patients with AD dementia approach institutionalisation, whereas patient healthcare costs increase only moderately
Summary
Cost-of-illness (COI) studies have shown that the two most important cost drivers in dementia care from a societal perspective are the costs of institutional care and the costs of informal care for patients who are cared for at home [1, 2].Time to institutionalisation ( referred to as ‘nursing home placement’ or ‘transition into a care home’) is often used as an outcome measure in Alzheimer’s disease (AD) dementia trials. Of the goals of AD dementia management (including drug treatment) is to improve treatment in the community setting and stabilise the course of the disease, which may prolong the time to institutionalisation of people with dementia [4, 5] This is especially true in high-income countries, where long-term institutional care constitutes a substantial part of care for people with dementia [6]. Delaying institutionalisation may increase the time patients with AD dementia can spend with their family and friends, improve quality of life and increase life expectancy [7] It may potentially be cost-saving from a societal perspective [5], this is not fully supported by current evidence [8, 9]
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