Abstract
ObjectiveTo analyse predictors of costs in dementia from a societal perspective in a longitudinal setting.MethodHealthcare resource use and costs were assessed retrospectively using a questionnaire in four waves at 6-month intervals in a sample of dementia patients (N = 175). Sociodemographic data, dementia severity and comorbidity at baseline, cognitive impairment and impairment in basic and instrumental activities of daily living were also recorded. Linear mixed regression models with random intercepts for individuals were used to analyse predictors of total and sector-specific costs.ResultsImpairment in activities of daily living significantly predicted total costs in dementia patients, with associations between basic activities of daily living and formal care costs on the one and instrumental activities of daily living and informal care costs on the other hand. Nursing home residence was associated with lower total costs than residence in the community. There was no effect of cognition on total or sector-specific costs.ConclusionCognitive deficits in dementia are associated with costs only via their effect on the patients' capacity for activities of daily living. Transition into a nursing home may reduce total costs from a societal perspective, owing to the fact that a high amount of informal care required by severely demented patients prior to transition into a nursing home may cause higher costs than inpatient nursing care.
Highlights
For Germany, the costs of illness (COI) of dementia in the population aged 65 and older were J 10.285 billion (US-$ 14.296 billion) in 2008, according to federal statistics [1]
There is ample evidence to show that costs in dementia are generally characterised by three patterns: first, costs of dementia are to a large extent costs of nursing care, second, costs of nursing care increase substantially over the course of the disease, and third, informal care accounts for a substantial share of total costs if patients are cared for in the community
A comparison of baseline data for subjects with complete follow-up and for those who dropped out of the cohort at any stage after the baseline assessment indicated that drop-outs were initially more severely impaired, which was evident in MMSE scores, Barthel scores, instrumental activities of daily living (IADL) scores and GDS scores (Table 3)
Summary
For Germany, the costs of illness (COI) of dementia in the population aged 65 and older were J 10.285 billion (US-$ 14.296 billion) in 2008, according to federal statistics [1] This corresponded to 8.4% of all costs of illness in the same age bracket, which makes dementia one of the most expensive disease categories in old age. In a study which analysed a mixed sample of dementia patients living in the community or in a nursing home as well as non-demented control subjects drawn from the AgeCoDe cohort, we found annual excess costs of J 15,500 in mild, J 31,600 in moderate and J 41,800 in severe dementia at year 2008 values (corresponding to US-$ 21,550, 43,920 and 58,100, respectively) [8]. Across disease stages approximately half of all costs were due to informal care
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