Abstract
BackgroundAlzheimer’s disease (AD), the commonest cause of dementia, represents a significant cost to UK society. This analysis describes resource utilisation, costs and clinical outcomes in non-institutionalised patients with AD in the UK.MethodsThe GERAS prospective observational study assessed societal costs associated with AD for patients and caregivers over 18 months, stratified according to baseline disease severity (mild, moderate, or moderately severe/severe [MS/S]). All patients enrolled had an informal caregiver willing to participate in the study. Healthcare resource utilisation was measured using the Resource Utilization in Dementia instrument, and 18-month costs estimated by applying unit costs of services and products (2010 values). Total societal costs were calculated using an opportunity cost approach.ResultsOverall, 526 patients (200 mild, 180 moderate and 146 MS/S at baseline) were recruited from 24 UK centres. Mini-Mental State Examination (MMSE) scores deteriorated most markedly in the MS/S patient group, with declines of 3.6 points in the mild group, 3.5 points in the moderate group and 4.7 points in the MS/S group; between-group differences did not reach statistical significance. Patients with MS/S AD dementia at baseline were more likely to be institutionalised (Kaplan–Meier probability 28% versus 9% in patients with mild AD dementia; p < 0.001 for difference across all severities) and had a greater probability of death (Kaplan–Meier probability 15% versus 5%; p = 0.013) at 18 months. Greater disease severity at baseline was also associated with concomitant increases in caregiver time and mean total societal costs. Total societal costs of £43,560 over 18 months were estimated for the MS/S group, versus £25,865 for the mild group and £30,905 for the moderate group (p < 0.001). Of these costs, over 50% were related to informal caregiver costs at each AD dementia severity level.ConclusionsThis study demonstrated a mean deterioration in MMSE score over 18 months in patients with AD. It also showed that AD is a costly disease, with costs increasing with disease severity, even when managed in the community: informal caregiver costs represented the main contributor to societal costs.
Highlights
Alzheimer’s disease (AD), the commonest cause of dementia, represents a significant cost to UK society
Inclusion criteria were communitydwelling patients, aged at least 55 years, presenting within the normal course of clinical care, diagnosed with probable AD dementia according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association criteria [10], with a Mini-Mental State Examination (MMSE) score [11] of ≤26 points, and with an informal caregiver who was willing to participate in the study and undertake responsibility for the patient for at least 6 months of the year
Among patients assessed as having mild disease at baseline, 43.5% remained with mild disease, 36.7% transitioned from mild to moderate disease, 11.6% transitioned from mild to moderately severe/severe disease, and 8.2% had an MMSE score of >26
Summary
Alzheimer’s disease (AD), the commonest cause of dementia, represents a significant cost to UK society. Based on 2013 UK population data, the Alzheimer’s Society estimated the total age-standardised population prevalence of dementia to be 7% in those aged 65 years and over, equivalent to one in every 14 people in that age group [2] At this rate of prevalence, approximately 850,000 individuals within the UK were expected to be affected by dementia in 2015 [2]. Informal care costs often form the majority of total costs [5] As many of these and other studies use different methodologies ranging from multi-country clinical trial data and retrospective questionnaires, the robustness of the data has been questioned [6] and the difficulties of comparing studies has been highlighted [7]
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