Projected costs of dementia and quality adjusted life years lost between 2020‐2050: a population‐based microsimulation study

Abstract

AbstractBackgroundThe total cost of dementia has passed the $1 trillion mark in 2018 and dementia was the sixth most burdensome disease in 2016, causing an immense loss of quality adjusted life years (QALYs). Due to population ageing, costs and burden will further increase. We have quantified the expected future increase in costs and QALYs lost due to dementia.MethodWe used the microsimulation model MISCAN‐Dementia to simulate the life history and development of dementia of 10 million individuals. MISCAN‐Dementia synthesizes population‐based Rotterdam Study data with changes in demographics between birth cohorts from the early 1900s onwards. We assumed cost (from a societal perspective) and disutility values for patients and caregivers by dementia severity stage (MCI, mild, moderate, severe) and setting (home, institution). We determined costs and QALYs lost from 2020‐2050 for three different dementia risk trend scenarios: 1) stable age‐specific incidence, 2) linear decline by 13% per decade, 3) nonlinear declines averaging 13% per decade.ResultWe estimated total costs of dementia in 2020 at 13 billion euros and QALYs lost at 90,000 years for the general Dutch population, irrespective of the trend scenario. Assuming a stable age‐specific incidence resulted in costs of 29 billion euros and 207,000 QALYs lost in the year 2050, corresponding to a 124% increase compared to 2020. In contrast, the linearly declining trend resulted in 19 billion euros (95%CI: 15‐24) and 135,000 QALYs lost (95%CI: 106,000‐169,000) in 2050, translating into a 53% increase compared to 2020. Over the time horizon, costs and QALYs lost are roughly similar between dementia stages, although people spend more time with less severe disease (50% mild, 30% moderate, and 20% severe dementia). Similarly, costs of institutionalized care (30% of life years spent with dementia) are roughly equal to the costs while living at home (70% of life years spent with dementia).ConclusionBy 2050, the annual costs of dementia will increase to 19‐29 billion euros and dementia will cause 135,000‐207,000 QALYs lost per year. These projections highlight the need for policymakers and health care systems to prepare for an increase in the burden of dementia.