Informal Caregiving Costs Research Articles

The hidden costs of informal caregiving: a concept analysis

Background“The hidden costs of informal caregiving” is an interdisciplinary concept. While caregivers make a significant contribution to the process of caregiving, they sacrifice their leisure time, and incur risks of dropping out of the job, impaired mental and physical health, and decreased well-being within the context of caregiving. Those invisible sacrifices are often overlooked and described as hidden costs of informal caregiving. However, the conceptualisation of hidden costs of informal caregiving has not yet been clarified and scientifically assessed. The research aimed to clarify the concept of hidden costs of informal caregiving and develop an operational definition.MethodsWalker and Avant’s concept analysis was conducted. Databases of CBM, CNKI, WanFang, VIP, PubMed, Embase, CINAHL, Web of Science, MEDLINE, Cochrane Library, Econlit, CINAHL and ProQuest were searched with the term “hidden costs of informal caregiving”. Information about the uses of the concept, defining attributes, model cases, antecedents, consequences and empirical referents of hidden costs of informal caregiving was extracted and synthesized.ResultsA total of 25 articles were included. The six defining attributes of hidden costs of informal caregiving were identified as including “undertaken by informal caregivers”, “the time costs of caregiving”, “costs of career development” “physical well-being costs”, “mental well-being costs” and “social relationship costs”. Personal characteristics of the caregivers and care recipients, along with caregiving attributes, were among the antecedents. The consequences of hidden costs of informal caregiving resulted in negative influences which included poor quality of life, life-altering decisions, options for the type of care, some degree of economic hardship, decreased compliance with treatment plans and monetary value informal caregivers are willing to pay to be replaced.ConclusionThis concept analysis decisively illuminated the hitherto nebulous concept and expanded the contents of hidden costs of informal caregiving, which will foster a deeper appreciation of the invisible cost of caregivers. Moreover, it will provide a reference for the study of the hidden costs of informal caregiving in future, contribute to the development of assessment tools and theoretical models of hidden costs of informal caregiving, and create a basis for designing an evidence-based care program.

The cost of providing care by family and friends (informal care) in the last year of life: A population observational study

Introduction: Little is known about replacement costs of care provided by informal carers during the last year of life for people dying of cancer and non-cancer diseases. Aim: To estimate informal caregiving costs and explore the relationship with carer and decedent characteristics. Design: National observational study of bereaved carers. Questions included informal end-of-life caregiving into the 2017 Health Survey for England including estimated recalled frequency, duration and intensity of care provision. We estimated replacement costs for a decedent’s last year of life valuing time at the price of a substitutable activity. Spearman rank correlations and multivariable linear regression were used to explore relationships with last year of life costs. Setting/participants: Adult national survey respondents – England. Results: A total of 7997 adults were interviewed from 5767/9612 (60%) of invited households. Estimated replacement costs of personal care and other help were £27,072 and £13,697 per carer and a national cost of £13.2 billion and £15.5 billion respectively. Longer care duration and intensity, older age, death at home (lived together), non-cancer cause of death and greater deprivation were associated with increased costs. Female sex, and not accessing ‘other care services’ were related to higher costs for other help only. Conclusion: We provide a first adult general population estimate for replacement informal care costs in the last year of life of £41,000 per carer per decedent and highlight characteristics associated with greater costs. This presents a major challenge for future universal care coverage as the pool of people providing informal care diminish with an ageing population.

Racial and Ethnic Disparities in the Monetary Value of Informal Caregiving for Non-Institutionalized People Living With Dementia.

To examine racial and ethnic differences in costs of informal caregiving among older adults with dementia in the United States. We used data from the 2002 to 2018 Health and Retirement Survey to estimate annual informal care hours for adults with dementia (n = 10,015). We used regression models to examine racial and ethnic differences in hours of informal care for activities of daily living (ADL) and instrumental ADL, controlling for demographic characteristics, education, and level of disability. Our sample was 70% non-Hispanic White, 19% non-Hispanic Black, and 11% Hispanic. Hispanics received, on average, 35.8hours of informal care each week, compared to 30.1 for Blacks and 20.1 for Whites. Racial and ethnic differences persisted when controlling for covariates. Informal care is a greater cost to racial and ethnic minoritized families. Informal care was valued at a replacement cost of $44,656 for Hispanics, $37,508 for Blacks, and $25,121 for Whites.

Long-run consequences of informal elderly care and implications of public long-term care insurance

We estimate a dynamic structural model of labor supply, retirement, and informal caregiving to study short and long-term costs of informal caregiving in Germany. Incorporating labor market frictions and the German tax and benefit system, we find that in the absence of Germany’s public long-term insurance scheme, informal elderly care has adverse and persistent effects on labor market outcomes and, thus, negatively affects lifetime earnings and future pension benefits. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that while public long-term care insurance policies are fiscally costly and induce negative labor market effects, they can largely offset the personal costs of caregiving and increase welfare, especially for low-income individuals.

U.S. dementia care spending by state: 2010-2019.

Dementia is the fourth largest cause of death for individuals 70 years of age and older in the United States, and it is tremendously costly. Existing estimates of the indirect costs of dementia are dated and do not report on differences across the United States. We used data from multiple surveys to create cost estimates and projections for informal dementia caregiving at the U.S. state level from 2010 through 2050. In 2019, the annual replacement cost of informal caregiving was $42,422 per prevalent case, and the forgone wage cost was $10,677 per prevalent case. In 2019, it would have cost $230 billion to hire home health aides to provide all this care. If past trends persist, this cost is expected to grow to $404 billion per year in 2050. The cost of informal care varied substantially by state and is expected to grow through at least 2050. In the United States in 2019, foregone wages due to informal dementia care was $58 billion. Replacing informal dementia care with health aides would have cost $230 billion. These costs vary dramatically by state, even when assessed per prevalent case. These costs are expected to nearly double by 2050.

The impact of poisoning in British Columbia: a cost analysis.

Poisoning, from substances such as illicit drugs, prescribed and over-the-counter medications, alcohol, pesticides, gases and household cleaners, is the leading cause of injury-related death and the second leading cause for injury-related hospital admission in British Columbia. We examined the health and economic costs of poisoning in BC for 2016, using a societal perspective, to support public health policies aimed at minimizing losses to society. Costs by intent, sex and age group were calculated in Canadian dollars using a classification and costing framework based on existing provincial injury data combined with data from the published literature. Direct cost components included fatal poisonings, hospital admissions, emergency department visits, ambulance attendance without transfer to hospital and calls to the British Columbia Drug and Poison Information Centre (BC DPIC) not resulting in ambulance attendance, emergency care or transfer to hospital. Indirect costs, measured as loss of earnings and informal caregiving costs, were also calculated. We estimate that poisonings in BC totalled $812.5 million in 2016 with $108.9 million in direct health care costs and $703.6 million in indirect costs. Unintentional poisoning injuries accounted for 84% of total costs, 46% of direct costs and 89% of indirect costs. Males accounted for higher proportions of direct costs for all patient dispositions except hospital admissions. Patients aged 25-64 years accounted for higher proportions of direct costs except for calls to BC DPIC, where proportions were highest for children younger than 15 years. Hospital care expenditures represented the largest direct cost of poisoning, and lost productivity following death represented the largest indirect cost. Quantifying and understanding the financial burden of poisoning has implications not only for government and health care, but also for society, employers, patients and families.

IMPACT OF OLDER ADULTS’ INTERNET USE ON THE ECONOMIC BURDEN OF INFORMAL CAREGIVING

Abstract Objectives Digital technology enables older adults to live independently by handling health-related tasks or shopping/banking online, thus can reduce care burden. This study examines the impact of older adults’ Internet use on formal and informal care hours and its influence on estimating cost savings with active and potential Internet users. Methods Medicare beneficiaries ages 65 and above with functional difficulties were sampled from the 2015 National Health and Aging Trends Study (N=1,806). Care is measured by total hours for help older adults received in the past month, separated by formal and informal care. Internet use for health-related tasks and shopping/banking were measured. A survey weighted two-part model with gamma distribution was estimated. The cost savings of informal caregiving was estimated by a replacement approach. Results Older adults' health-related Internet use substantially reduced informal care hours by 27.7% (19.8 hours per month, p < .05), but not for formal care hours. A monthly estimated cost reduction of informal caregiving was $3,094 per an older adult with functional difficulties by applying 2020 median wage of home health aide workers. The annual savings in the cost of informal caregiving associated with older adults’ health-related Internet use is estimated to be $8.1 billion with the active users and additionally $20.1 billion with the potential health-related Internet users in the US. Discussion: Promoting health-related Internet use among older adults with functional difficulties to relieve economic burden of informal caregiving will be discussed.

Occupational Exposure to Wood Dust and the Burden of Nasopharynx and Sinonasal Cancer in Canada.

Background: Millions of workers around the world are exposed to wood dust, as a by-product of woodworking. Nasopharynx cancers (NPCs) and sinonasal cancers (SNCs) are two cancers that can be caused by occupational exposure to wood dust, but there is little evidence regarding their burden in Canada. Objective: the aim of this study was to estimate the incidence and economic burden of newly diagnosed cases of NPC and SNC in 2011 in Canada, attributable to occupational exposures to wood dust. Methods: calculating the incidence of cancer attributable to occupational exposure involved three steps of defining relative risk, assessing the prevalence of exposure and population modelling. We estimated the lifetime costs of newly diagnosed NPC and SNC from the societal perspective. The three major cost categories that we considered were direct costs (healthcare costs, out-of-pocket costs, and informal caregiving costs), indirect costs (labour productivity/output costs, employer adjustment costs, and home production losses), and intangible costs (health-related quality of life losses). To generate an estimate of economic burden, we used secondary data from multiple sources and applied them to our computational model developed from an extensive literature review. Results: From approximately 1.3 million workers exposed to wood dust, we expected 28%, 43% and 29% were exposed to low, medium, and high levels, respectively. We estimated from 235 newly diagnosed cases of NPC and 245 newly diagnosed cases of SNC, 4.6% (11 cases) and 4.4% (11 cases) were attributed to occupational exposure to wood dust, respectively. Our estimates of the economic burden of occupational NPC and SNC were about CAD 5.4 million (CAD 496,311 per-case) and CAD 6.7 million (CAD 627,437 per-case), respectively. For NPC direct costs constituted approximately 20% of all costs, and indirect and intangible costs accounted for 55% and 25%, while for SNC the breakdown distribution were 16%, 42% and 42%, respectively. Conclusions: Our estimates highlighted the importance of occupational NPC and SNC amongst other occupational cancers, especially in countries with large wood-related industries. This paper also serves the information needs of policymakers who are seeking to make evidence-based decisions about occupational cancer prevention efforts.

Toward a broader concept of societal value: family spillovers in Alzheimer's disease.

Recognizing that the "healthcare sector perspective" can be too limited in some situations, the National Institute of Health and Care Excellence (NICE), Institute for Clinical and Economic Review (ICER), and the U.S. Second Panel on Cost-Effectiveness in Health and Medicine all recommend a "societal" perspective in "reference case" cost-effectiveness analyses (CEAs). Although costs of informal caregiving are sometimes included in the CEAs of Alzheimer's Disease (AD) drugs, the benefits and disutility to family members, referred to as "family spillovers" by the U.S. Second Panel, are usually omitted. We estimate that the aggregate cost of family spillovers could be substantial in the USA-on the order of USD 57 billion or over 10 percent of the total economic burden of AD in 2020. Incorporation of family spillovers in AD value frameworks and HTAs is important for comprehensively defining, rewarding, and providing high-value care in AD.

Insights in the pathophysiology of haemorrhagic strokes in a sub-Sahara African country, an epidemiological and MRI study.

Intra-cerebral Haemorrhage (ICH) seems more prevalent in sub-Saharan Africa (SSA) than in High-Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns. Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme-ULB Hospital and at Conakry Ignace Deen-UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen-UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels' initial cohort. Paired Student's t-test and Mann-Whitney u-test were used for group comparisons. Age of ICH onset was higher in Belgium (68±17years vs. 56±14years, P<0.01) while ICH volume and 30-day mortality rate were higher in Guinea (20ml vs. 11ml, P<0.01 and mortality 33% vs. 10 %, P<0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P=0.09) and poor outcomes in 10.3% vs. 29.6% (P<0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics. Intra-cerebral Haemorrhage affected patients 15years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.

Estimation of direct and indirect costs of occupational injuries: A case study in one of the refining industries in Iran in 2015

Introduction: Occupational injuries can impose a significant cost to the country’s economy. In developing countries, it is usually difficult to get access to occupational injuries data mainly because the lack of appropriate reporting and recording system, and in these countries, making it difficult to accurately estimate the costs of these injuries. The purpose of this study is to estimate the direct and indirect costs of occupational injuries in one of the Iranian refining industries. Materials and Methods: This cross-sectional study was performed on all occupational injuries, including outpatient injuries to deaths in 2015. Data was collected based on a bottom-up approach, by using the recorded documents and a researcher-made questionnaire. Lastly the direct and indirect costs for different stockholders, including workers and their families, industry and society as a whole, were calculated. Investigated direct costs of occupational injuries included The healthcare costs, out of pocket cost and informal caregiving and Indirect costs included productivity losses, reorganization and investigation costs and home production costs. Results: It is estimated that occupational injuries impose 103,385 million Rials to the society over a year. Investigated direct costs of occupational injuries imposed 14,152 million Rials (48 million Rials per case). Indirect costs imposed 89,232 million Rials to the society (308 million Rials per case). Also the average healthcare cost per case for fatal injuries is estimate 125 million, for serious injuries 12 million Rials and for outpatient injuries 780,000 Rials Conclusion: According to the results of the study, occupational injuries annually bring significant economic costs to the industry, workers and their families which a significant portion of these costs are indirect costs. These results indicates the status and importance of occupational injuries and therefore can be used by decision-makers and planners in occupational health-related issues.

Integrated palliative homecare in advanced dementia: reduced healthcare utilisation and costs

ObjectivesTo determine the economic benefit of an integrated home-based palliative care programme for advanced dementia (Programme Dignity), evaluation is required. This study aimed to estimate Programme Dignity’s average monthly cost...

Equity and the financial costs of informal caregiving in palliative care: a critical debate

BackgroundInformal caregivers represent the foundation of the palliative care workforce and are the main providers of end of life care. Financial pressures are among the most serious concerns for many carers and the financial burden of end of life caregiving can be substantial.MethodsThe aim of this critical debate paper was to review and critique some of the key evidence on the financial costs of informal caregiving and describe how these costs represent an equity issue in palliative care.ResultsThe financial costs of informal caregiving at the end of life can be significant and include carer time costs, out of pocket costs and employment related costs. Financial burden is associated with a range of negative outcomes for both patient and carer. Evidence suggests that the financial costs of caring are not distributed equitably. Sources of inequity are reflective of those influencing access to specialist palliative care and include diagnosis (cancer vs non-cancer), socio-economic status, gender, cultural and ethnic identity, and employment status. Effects of intersectionality and the cumulative effect of multiple risk factors are also a consideration.ConclusionsVarious groups of informal end of life carers are systematically disadvantaged financially. Addressing these, and other, determinants of end of life care is central to a public health approach to palliative care that fully recognises the value of carers. Further research exploring these areas of inequity in more depth and gaining a more detailed understanding of what influences financial burden is required to take the next steps towards meeting this aspiration. We will address the conclusions and recommendations we have made in this paper through the work of our recently established European Association of Palliative Care (EAPC) Taskforce on the financial costs of family caregiving.

Residential Setting and the Cumulative Financial Burden of Dementia in the 7 Years Before Death.

Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings. Using the Health and Retirement Study (HRS) and linked claims, we examined total healthcare spending and proportion by payer-Medicare, Medicaid, out-of-pocket, and calculated costs of informal caregiving-over the last 7 years of life, comparing those with and without dementia and stratifying by residential setting. The HRS is a nationally representative longitudinal study of older adults in the United States. We sampled HRS decedents from 2004 to 2015. To ensure complete data, we limited the sample to those 72 years or older at death who had continuous fee-for-service Medicare Parts A and B coverage during the 7-year period (n = 2909). We compared decedents with dementia at last HRS assessment with those without dementia across annual and cumulative 7-year spending measures, and personal characteristics. We present annual and cumulative spending by payer, and the changing proportion of spending by payer over time, comparing those with and without dementia and stratifying results by residential setting. We found that, consistent with prior studies, people with dementia experience significantly higher costs, with a disproportionate share falling on patients and families. This pattern is most striking among community residents with dementia, whose families shoulder 64% of total expenditures (including $176,180 informal caregiving costs and $55,550 out-of-pocket costs), compared with 43% for people with dementia residing in nursing homes ($60,320 informal caregiving costs and $105,590 out-of-pocket costs). These findings demonstrate disparities in financial burden shouldered by families of those with dementia, particularly among those residing in the community. They highlight the importance of considering the residential setting in research, programs, and policies. J Am Geriatr Soc 68:1319-1324, 2020.

Costs and Resource Use Associated with Community-Dwelling Patients with Alzheimer's Disease in Japan: Baseline Results from the Prospective Observational GERAS-J Study.

Background:As the Japanese population ages, caring for people with Alzheimer’s disease (AD) dementia is becoming a major socioeconomic issue.Objective:To determine the contribution of patient and caregiver costs to total societal costs associated with AD dementia.Methods:Baseline data was used from the longitudinal, observational GERAS-J study. Using the Mini-Mental State Examination (MMSE) score, patients routinely visiting memory clinics were stratified into three groups based on AD severity. Health care resource utilizationwas recorded using the Resource Utilization in Dementia questionnaire. Total monthly societal costs were estimated using Japan-specific unit costs of services and products (patient direct health care use, patient social care use, and informal caregiving time). Uncertainty around mean costs was estimated using bootstrapping methods.Results:Overall, 553 community-dwelling patients withADdementia (28.3% mild[MMSE21-26], 37.8% moderate[MMSE 15-20], and 34.0% moderately severe/severe [MMSE < 14]) and their caregivers were enrolled. Patient characteristics were: mean age 80.3 years, 72.7% female, and 13.6% living alone. Caregiver characteristics were: mean age 62.1 years, 70.7% female, 78.8% living with patient, 49.0% child of patient, and 39.2% sole caregiver. Total monthly societal costs of AD dementia (Japanese yen) were: 158,454 (mild), 211,301 (moderate), and 294,224 (moderately severe/severe). Informal caregiving costs comprised over 50% of total costs.Conclusion:Baseline results of GERAS-J showed that total monthly societal costs associated with AD dementia increased with AD severity. Caregiver-related costs were the largest cost component. Interventions are needed to decrease informal costs and decrease caregiver burden.

The Economic Cost and Burden of Informal Caregiving for the Inpatient: The Case of Lemlem Karl Hospital, Maichew, Ethiopia

The objective of this study is to present new empirical findings about the economics of informally supplied health care with special emphasis on the labor market-related opportunity cost and to measure the burden of informal caregiving for the inpatient at Lemlem Karl hospital, Maichew, Ethiopia. The study employs ordinary list square and ordered logit method of regression. In addition, the study also employed measurement mechanisms like; opportunity cost, proxy good and Zarit Burden Scale. The mean time spent on informal caregiving was 73.18 hours/4.1days and the mean cost of informal caregiving for the inpatient at Lemlem Care Hospital by using the opportunity cost and proxy good valuation method is 689.56birr (23.74$) and 724.653 birr (24.5$) per 4.1 days respectively. The study also measures caregiver’s burden level by using Zarit Burden Scale and the result depict that of the total respondents 51 (38.06%) affected by moderate caregiving burden and followed by 41 (30.60%) of the respondents with little caregiving burden. To reduce the cost and burden of principal informal caregivers and to fill this gap the following policy recommendations are made based on the findings of the study and the experience of the rest of the world. Enable informal caregivers to balance personal and social life with care responsibilities through respite care, develop and deploy a national caregiving strategy and the strategy should at a minimum include three policies; (a) Policy Related to Workplace Accommodation; (b) Financial Assistance policy; (c) Investment in informal caregiving research and development related projects.

Factors associated with long-term impact on informal caregivers during Alzheimer's disease dementia progression: 36-month results from GERAS.

To identify, in caregivers of patients with Alzheimer's disease (AD) dementia, factors associated with subjective (personal, physical, emotional, and social) and objective (informal caregiver time and costs) caregiver burden. Prospective longitudinal European observational study: post-hoc analysis. Clinic. Community-dwelling patients in France and Germany aged ≥ 55 years (n = 969) with probable AD and their informal caregivers. Mini-Mental State Examination (MMSE), Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL), 12-item Neuropsychiatric Inventory (NPI-12), Zarit Burden Interview (ZBI), informal caregiver basic and instrumental ADL hours (Resource Utilization in Dementia instrument), and informal caregiver costs. Mixed-effect models of repeated measures (MMRM) were run, including baseline and time-dependent covariates (change from baseline [CFB] to 18 months in MMSE, ADCS-ADL, and NPI-12 scores) associated with CFB in ZBI score/informal caregiver time over 36 months (analyzed using linear regression models) and informal caregiver costs over 36 months (analyzed using generalized linear models). Greater decline in patient function (ADCS-ADL) over 18 months was associated with increased subjective caregiver burden (ZBI), hours, and costs over 36 months. Increased behavioral problems (NPI-12) over 18 months also negatively impacted ZBI. Cognitive decline (MMSE) over 18 months did not affect change in caregiver burden. Long-term informal caregiver burden was driven by worsening functional abilities and behavioral symptoms but not cognitive decline, over 18 months in community-dwelling patients with AD dementia. Identifying the drivers of caregiver burden could highlight areas in which interventions may benefit both caregivers and patients.

Economic costs and health-related quality of life associated with individual specific reminiscence: Results from the InspireD Feasibility Study.

Recent studies have focused on the use of technology to support reminiscence but there remains a dearth of research on the health costs and benefits associated with this intervention. The aim of this study was to estimate costs and quality of life associated with a home based, individual specific reminiscence intervention, facilitated by an iPad app for people living with dementia and their family carers, with a view to informing a future cost-effectiveness analysis. Use of community health and social care services, hospital services, prescribed medication and informal caregiving was assessed using an adapted version of the Client and Socio-Demographic Service Receipt Inventory (CSRI) at baseline and 3-month follow-up. Quality of life was assessed at baseline, 6-week and 3-month follow-up using the EQ5D, DEMQOL and DEMQOL proxy instruments. Results showed that average health and social care costs were £29,728 per person at baseline (T0) and £33,436 after 3 months (T2). Higher T2 costs were largely accounted for by higher informal caregiving costs. There was an overall increase in health-related quality of life over the duration of the intervention, although there were notable differences in index scores generated by the EQ5D (0.649, 0.652 and 0.719) and DEMQOL instruments (0.845, 0.968 and 0.901). The study concluded that a full cost-effectiveness analysis could incorporate a similar range of cost-categories with minor amendments to the CSRI to improve the accuracy of cost estimation. Furthermore, a larger sample size, randomisation and longer follow-up period are required to allow potential effects of the intervention to be realised and differences between intervention and control groups to be accurately detected.

Differences in Medicare Utilization and Expenditures in the Last Six Months of Life among Patients with and without Alzheimer's Disease and Related Disorders.

Previous research has not focused on differences at the end of life among Medicare beneficiaries with, and without, a diagnosis of Alzheimer's disease and related disorders (ADRDs). The purpose of this study was to examine differences in utilization of inpatient services and Medicare expenditures (overall and by category) in the last six months of life for patients with, versus those without, a diagnosis of ADRD. The study used 2013 Medicare Research Identifiable Files (5% sample) to study utilization and expenditures for a full six months before death (n = 7895 for ADRD; n = 30,639 for non-ADRD). A generalized linear model with a gamma distribution was used to examine the association of ADRD with end-of-life service utilization and expenditures. ADRD patients were overall less expensive than their non-ADRD peers through reduced use of high-cost services, and urban patients were more likely than rural patients to use hospice and other services among both the ADRD and non-ADRD groups. After controlling for age, gender, race, dual eligibility, residence, region, chronic conditions, and type of service utilization, ADRD beneficiaries cost Medicare 11% less than non-ADRD beneficiaries (p < 0.01). Future research should examine the informal caregiving costs of caring, which is a significant part of care for an ADRD patient, as the residential setting of the beneficiary highly influences costs.

PND47 - ECONOMIC BURDEN OF ALZHEIMER’S DISEASE IN THE UK

To collate evidence from published studies evaluating the economic burden of Alzheimer’s disease (AD) in the UK. A literature search was conducted in Embase® and MEDLINE® to identify evidence published from 2013 to 2018. The studies were assessed against predefined eligibility criteria. Studies were included if they were published in English and reported economic burden associated with AD in the UK. Of the 768 publications retrieved, seven studies were included. The GERAS study reported 18-month societal costs as £37,900/patient (Lenox-Smith et al., 2016). Also, mean informal caregiver costs were higher among patients with moderately severe/severe AD (£24,672) compared to those with moderate (£17,007) and mild (£15,678) AD. The LASER-AD study reported significantly higher average per capita annual costs for AD patients with neuropsychiatric inventory (NPI) agitation scores >3 than those with NPI scores ≤3 (£38,910 vs £27,752; p<0.001) (Morris et al., 2015). The DADE study reported higher mean non-medical costs of care for AD patients compared to mean medical costs of care over a period of 3 months (£,2924 versus £1,094) (Jones et al. 2015). The study by Chen and colleagues reported a higher mean rate of hospitalisation for AD patients compared to patients without AD (23.3% versus 18.4%; p<0.0001) (Chen et al., 2014). Another study reported the mean number of hospital days for AD patients as 6.92 days per person-year (Mueller et al., 2018). Furthermore, AD patients had either a general hospital admission (37.04%) or care home admission (11.73%), and 6.34% of patients received at least one mental health inpatient admission during 6-month study period (Knapp et., 2016). There is a high economic burden of AD in the UK. The major contributing factors are disease severity (including NPI agitation score) and hospital admissions.