Direct medical costs and source of cost differences across the spectrum of cognitive decline: A population-based study

Published: April 6, 2015
Category: Bibliography > Papers
Authors: Duhig AM, Emerson JA, Hass SL, Leibson CL, Long KH, Pankratz VS, Petersen RC, Ransom JE, Roberts RO, Smith CY
Countries: United States
Language: null
Types: Finance/Budgeting, Population Health
Settings: Hospital, PCP

Alzheimers Dement.

Mayo Clinic, Rochester, MN, USA; K Long Health Economics Consulting LLC, St. Paul, MN, USA; AbbVie, North Chicago, IL, USA

BACKGROUND: Objective cost estimates and source of cost differences are needed across the spectrum of cognition, including cognitively normal (CN), mild cognitive impairment (MCI), newly discovered dementia, and prevalent dementia.

METHODS: Subjects were a subset of the Mayo Clinic Study of Aging stratified-random sampling of Olmsted County, MN, residents aged 70 to 89 years. A neurologist reviewed provider-linked medical records to identify prevalent dementia (review date = index). Remaining subjects were invited to participate in prospective clinical/neuropsychological assessments; participants were categorized as CN, MCI, or newly discovered dementia (assessment date = index). Costs for medical services/procedures 1-year pre-index (excluding indirect and long-term care costs) were estimated using line-item provider-linked administrative data. We estimated contributions of care-delivery site and comorbid conditions (including and excluding neuropsychiatric diagnoses) to between-category cost differences.

RESULTS: Annual mean medical costs for CN, MCI, newly discovered dementia, and prevalent dementia were $6042, $6784, $9431, $11,678, respectively. Hospital inpatient costs contributed 70% of total costs for prevalent dementia and accounted for differences between CN and both prevalent and newly discovered dementia. Ambulatory costs accounted for differences between CN and MCI. Age-, sex-, education-adjusted differences reached significance for CN versus newly discovered and prevalent dementia and for MCI versus prevalent dementia. After considering all co-morbid diagnoses, between-category differences were reduced (e.g., prevalent dementia minus MCI (from $4842 to $3575); newly discovered dementia minus CN (from $3578 to $711)). Following the exclusion of neuropsychiatric diagnoses from co-morbidity adjustment, between-category differences tended to revert to greater differences.

CONCLUSIONS: Cost estimates did not differ significantly between CN and MCI. Substantial differences between MCI and prevalent dementia reflected high inpatient costs for dementia and appear partly related to co-occurring mental disorders. Such comparisons can help inform models aimed at identifying where, when, and for which individuals proposed interventions might be cost-effective.

PMID: 25858682

United States,Co-morbidity,Psychiatric,Targeted Program,Cost Burden Evaluation,Aged,80 and over,Aging,Cognition Disorders/diagnosis,Cognition Disorders/epidemiology,Community Health Planning,Cross-Sectional Studies,Databases,Factual/statistics & numerical data,Databases,Factual/utilization,Dementia/economics,Dementia/epidemiology,Dementia/therapy,Disease Progression,Gender,Neuropsychological Tests

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