Medical Costs along the Trajectory of Cognitive Decline in the Elderly: A Population-Based Study (P07.157)

Abstract

Objective: Provide population-based estimates of medical costs across the full range of cognitive status. Background The impact of cognitive decline on medical costs is well recognized but poorly estimated. Design/Methods: Subjects were a subset of the population-based Mayo Clinic Study of Aging (MCSA). MCSA used Rochester Epidemiology Project resources to construct age- sex-stratified sampling frames of all Olmsted County, MN residents, aged 70-89 years. Of randomly-sampled subjects, 480 had confirmed prevalent dementia, based on neurologist9s review of all inpatient and ambulatory medical records. Remaining subjects were invited to participate in a prospective evaluation of cognitive status using comprehensive in-person and telephone neuropsychological assessments. Participants were categorized as normal (N=2,443), mild cognitive impairment (MCI) (N=536), or newly-discovered dementia (N=121). Using provider-linked billing data, all medical services and procedures received by study subjects 1-year before index (i.e., record review or assessment date) were costed and assigned nationally standardized wage- and inflation-adjusted dollar estimates. Estimates were compared across cognitive categories using Wilcoxon Rank Sum tests. Results: Percent male, mean age at index, and mean (median) pre-index costs for prevalent dementia, newly-discovered dementia, MCI, and normal categories, respectively were 45%, 45%, 52%, and 47%; 83, 83, 81, and 79 years; and $11,743 ($3,254), $9,374 ($2,028), $6,729 ($2,762), $6,036 ($2,217). Costs for dementia (prevalent plus newly-discovered) (mean=$11,266; median=2,992) did not differ from MCI (p=0.63) but were higher than normal costs (p Conclusions: As persons progress from normal through MCI and dementia, medical costs increase substantially. Further investigations will examine nursing home costs and identify factors underlying differences among individuals and cognitive categories. Supported by: Abbott Laboratories, National Institute on Aging. Disclosure: Dr. Leibson has received research support from Abbott Laboratories and NPS Pharmaceuticals. Dr. Hall Long received research support from Abbott Laboratories. Ms. Ransom has received research support from Abbott Laboratories and NPS Pharmaceuticals. Dr. Roberts has received research support from Abbott Laboratories. Dr. Hass has received personal compensation for activities with Abbott Laboratories as employee.Dr. Hass holds stock and/or stock options in Abbott Laboratories, which sponsored research in which Dr. Hass was involved as an investigator.Dr. Hass holds stock and/or stock options in Abbott Laboratories. Dr. Duhig has received personal compensation for activities with Abbott Laboratories as an employee.Dr. Duhig holds stock and/or stock options in Abbott Laboratories, which sponsored research in which Dr. Duhig was involved as an investigator.Dr. Duhig holds stock and/or stock options in Abbott Laboratories. Ms. Smith has received research support from Abbott Laboratories. Dr. Emerson has received research support from Abbott Laboratories. Dr. Pankratz has received research support from Abbott Laboratories, Inc. Dr. Petersen has received personal compensation for activities with Pfizer, Inc., Janssen Alzheimer9s Immunotherapy, Elan Pharmaceuticals, and GE Healthcare.