Fiscal consequences of Alzheimer's disease and informal care provision in the UK: A “government perspective” microsimulation

Abstract

• Alzheimer’s disease (AD) has a substantial impact on the UK government finances. • The fiscal loss to the UK government is £73,749 per person and carer affected by AD. • Welfare support and payments account for 60% of the estimated fiscal loss due to AD. • Lost earnings for informal carers are estimated at £27,189 over the AD continuum. • Total fiscal consequences of diseases should inform health policy decision-making. Estimating the fiscal consequences of Alzheimer’s disease (AD) on patients and informal carers using a UK public economic perspective. A simulated cohort of 1,000 pairs of people with AD and informal carers was compared with 1,000 demographically identical pairs in the general population. Both cohorts enter the model at the mean age of mild cognitive impairment onset. Time to AD onset was based on the literature and AD progression was modelled using published equations and a state-transition microsimulation. Labour participation, financial support, and paid taxes were linked to cognitive decline and caregiving needs using UK labour statistics and tax rates. Healthcare costs were based on published literature. Future costs and life-years were discounted at 3.5%. Results were reported as incremental differences in total tax revenue, financial support, and healthcare costs, over the AD continuum, between cohorts affected and unaffected by AD. Each AD-affected pair was associated with estimated incremental fiscal losses of £73,749 to the UK government. Financial support and healthcare costs were responsible for 59.3% and 22.2% of AD’s fiscal burden, respectively. Total lost tax revenue due to PwAD and carers’ reduced earnings represented 18.5% of total government losses. Sensitivity analyses confirmed the robustness of the results. Assuming mild cognitive impairment onset at age 60 let to incremental fiscal losses of £141,323 per AD-affected pair. Fiscal costs for entire UK population with AD were predicted to be £16 billion annually. Alzheimer’s disease strongly impacts UK’s public economy and should be considered to inform healthcare policymaking.