Economic Evaluation of Healthcare Resource Utilization and Costs for Newly Diagnosed Dementia-Related Psychosis.

Nazia Rashid,Muna Irfan,James B Wetmore,Victor Abler

doi:10.3390/geriatrics7020029

Abstract

This retrospective cohort study described changes in all-cause healthcare resource utilization (HCRU) and associated costs in dementia patients newly diagnosed with psychosis. Dementia and incident psychosis were identified using diagnostic and pharmacy claims using a Medicare 20% random sample dataset. All-cause HCRU and unweighted and weighted (by person-years of follow-up) HCRU-associated costs were evaluated in the year prior to and the 4 years following diagnosis of psychosis. In 49,509 dementia patients with psychosis, physician visits per patient per year increased from a mean of 26.7 (standard deviation (SD) 20.0) prior to psychosis to 38.4 (SD 41.9) post-psychosis diagnosis. The number of inpatient stay claims increased from 1.0 (SD 1.4) to 1.7 (SD 5.8). Mean unweighted costs for inpatient stays and home healthcare/hospice during 2008–2016 were USD 9989 and USD 3279 prior to a diagnosis of psychosis but increased to USD 25,982 and USD 9901 (weighted: USD 11,779 and USD 6709), respectively, in the year after a psychosis diagnosis. This pattern of a sharp increase in mean costs was also observed in costs adjusted to 2015 USD, and in both unweighted and weighted total and psychosis-related costs. These results indicate the importance of identifying newly diagnosed psychosis in dementia patients as well as the pressing need for management strategies and treatments that can reduce HCRU and costs.

Highlights

The natural course of dementia involves progressive neurodegeneration, a process accompanied by new and worsening symptoms, heightened caregiver burden, and increased utilization of medical and long-term care (LTC) resources [1]
Methods used here to identify patients with dementia and dementia-related psychosis were described in a previous report analyzing the risk of death and use of long-term care associated with dementia-related psychosis in the same patient population [19]
In this large-scale analysis of the Medicare beneficiaries, we found compelling increases in mean healthcare resource utilization (HCRU) and associated costs in the year following the appearance of newly diagnosed psychosis in patients with dementia

Summary

Introduction

The natural course of dementia involves progressive neurodegeneration, a process accompanied by new and worsening symptoms, heightened caregiver burden, and increased utilization of medical and long-term care (LTC) resources [1]. Healthcare resource utilization (HCRU) and associated costs are higher in patients with dementia-related NPS compared with dementia alone [4] and increase as NPS severity worsens [3–5]. Relative to patients with dementia alone, patients with dementia-related psychosis experience worse outcomes, including more rapid cognitive and functional decline [6,7], and an increased risk of institutionalization and death [8,9], both of which may translate to increased HCRU and costs. Patients with dementia who experience hallucinations and delusions are at a 1.6 times higher risk of institutionalization relative to patients without dementia-related psychosis [9]. Patients who suffer from dementia-related psychosis are more prone to falls than those with dementia alone, which can lead to acute hospitalizations and an associated increase in costs [11,12]. Current American Psychiatric Association guidelines caution against the use of such agents in these patients except when symptoms are severe, dangerous, and/or cause significant distress to the patient [14–16]

Methods

Results

Discussion

Conclusion