Health care resource utilisation in primary care prior to and after a diagnosis of Alzheimer's disease: a retrospective, matched case-control study in the United Kingdom.

Lei Chen,Catherine Reed,Allen Nyhuis,Alan Lenox-Smith,Michael Happich

doi:10.1186/1471-2318-14-76

Lei Chen, Catherine Reed + Show 3 more

Open Access

https://doi.org/10.1186/1471-2318-14-76

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Abstract

BackgroundThis study examined medical resource utilisation patterns in the United Kingdom (UK) prior to and following Alzheimer’s disease (AD) diagnosis.MethodsA patient cohort aged 65 years and older with newly diagnosed AD between January 2008 and December 2010 was identified through the UK’s Clinical Practice Research Datalink (CPRD). Patients with a continuous record in the CPRD (formerly the General Practice Research Database [GPRD]) for both the 3 years prior to, and the 1 year following, AD diagnosis were eligible for inclusion. A control cohort was identified by matching general older adult (GOA) patients to patients with AD based on year of birth, gender, region, and Charlson Comorbidity Index at a ratio of 2:1. Medical resource utilisation was calculated in 6-month intervals over the 4-year study period. Comparisons between AD and GOA control cohorts were conducted using conditional logistic regression for patient characteristics and a generalised linear model for resource utilisation.ResultsData for the AD cohort (N = 3,896) and matched GOA control cohort (N = 7,792) were extracted from the CPRD. The groups were 65% female and the AD cohort had a mean age of 79.9 years (standard deviation 6.5 years) at the date of diagnosis. Over the entire study period, the AD cohort had a significantly higher mean primary care consultation rate than the GOA cohort (p < .0001). While the GOA cohort primary care consultation rate gradually increased over the 4-year period (ranging from 5 to 7 consultations per 6-month period), increases were more pronounced in the AD cohort (ranging from 6 to 11 consultations per 6-month period, peaking during the 6-month periods immediately prior to and post diagnosis). The AD cohort also had a higher overall specialty referral rate than the GOA cohort over the 4-year period (37% vs. 25%, respectively; p < .0001); the largest difference was during the 6 months immediately prior to AD diagnosis (17% vs. 5%, respectively; p < .0001).ConclusionsIn the UK, AD diagnosis is associated with significant increases in primary and secondary care resource utilisation, continuing beyond diagnosis. This evidence may be important to health care commissioners to facilitate effective mobilisation of appropriate AD-related health care resources.

Highlights

This study examined medical resource utilisation patterns in the United Kingdom (UK) prior to and following Alzheimer’s disease (AD) diagnosis
More patients in the AD cohort than in the general older adult (GOA) cohort had reported depression (16.5% vs. 9.2%; p < .0001) and psychosis (0.31% vs. 0.04%; p = .0013); in contrast, fewer patients in the AD cohort had hypertension compared with GOA patients (9.3% vs. 10.5%; p = .0351) (Table 1)
The higher rates of primary care resource utilisation are evident in the AD cohort relative to GOA control patients as much as 3 years prior to AD diagnosis, with a sharp increase in the AD cohort immediately preceding the AD diagnosis that is maintained in the one year following diagnosis

Summary

Introduction

This study examined medical resource utilisation patterns in the United Kingdom (UK) prior to and following Alzheimer’s disease (AD) diagnosis. Across Europe, the 6.3 million patients living with dementia impose a high financial burden. With a total annual health care cost of €16.95 billion (€2673 per patient) and a total non-medical cost of €88.2 billion (€13,911 per patient), the impact of dementia on the financial health of Europe should not be under-estimated [1]. In the United Kingdom (UK) about 400,000 patients have AD [2], and the incidence rates double as age increases by 5 years (after 75 years of age) [3]. In a recent survey of UK patients with dementia, 68% had experienced a 1-year or longer delay in diagnosis, while 8% reported a delay of 5 years or longer [7]. Recent advances in brain imaging along with the identification of distinctive and reliable biomarkers [4] indicate potential for the diagnostic process to be more objective, there are issues of resources and reliability to be considered before these become part of routine care

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