THE NEED FOR DEVELOPMENT OF CARE PATHS FOR REDUCING HEALTH SERVICES UTILIZATION AMONG OLDER PEOPLE WITH ADVANCED COGNITIVE IMPAIRMENT LIVING IN RESIDENTIAL CARE HOMES

Abstract

of earlier rule-out of AD. The goal of this study was to test whether similar cost patterns existed among VD patients in the UK. Methods: A cohort of patients whose most recent diagnostic records for dementia indicated presence of VD was selected from de-identified Clinical Practice Research Datalink (CPRD) data (1989-2012). Patients were required to have no indication for other dementia types between or after their most recent VD diagnoses, have continuous data visibility for 6 months prior to their earliest indication of cognitive decline (index date), and have linkage to the Hospital Episode Statistics database. Patients were then stratified based on diagnosis of AD prior to their first confirmed VD diagnosis, and were followed for up to 5 years post-index. Patients with prior AD were matched to similar patients with no prior AD using propensity score methods. Annual excess healthcare costs estimated using the NHS reference costs for medical services and First DataBank prices for drugs were calculated comparing matched pairs in one year intervals, overall and stratified by time to confirmed diagnosis. Results: Of the 9,311 VD patients identified, 508 (w6%) had prior AD diagnoses. Among prior AD patients, median time to VD diagnosis exceeded two years from index (Figure 1). 502 patients with prior ADwere successfully matched for the cost analysis. Overall, patients with prior AD appeared to have higher annual healthcare costs over the follow up period. However, stratification by time to correct diagnosis revealed that, compared with matched counterparts, those with prior AD incurred substantially higher healthcare costs in periods leading up to and including their confirmed VD diagnosis, with excess costs quickly declining thereafter (Figure 2). Sensitivity analyses yielded similar findings. Conclusions: Similar to prior findings in the US, this retrospective analysis suggests that potential misdiagnosis of AD among UK patients with VD results in substantial excess costs. The decline in excess costs following the corrected diagnosis suggests potential benefits from earlier rule-out of AD.