Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial

Abstract

Background: Alzheimer's disease is the leading cause of dementia and affects about 25 million people worldwide. Recent studies have evaluated the effect of early interventions for dementia, but few studies have considered private time and transportation costs associated with the intervention. This study assessed the total economic costs associated with a multifaceted intervention for mild Alzheimer's disease, including an estimate of the ratio of public to private costs.

Methods: The study sample comprised 163 dyads of patients and caregivers who received a multifaceted intervention of counselling sessions, courses and informational packages. The typical duration of the intervention was 7 months. A micro-costing approach was applied using prospectively collected data on resource utilisation that included estimates of participant time and transportation. Precision estimates were calculated using a bootstrapping technique and structural uncertainty was assessed with sensitivity analysis.

Results: The direct intervention cost was estimated at EUR 1,070 (95% CI 1,029;1,109). The total cost (including private costs) was estimated at EUR 2,020 (95% CI 1,929;2,106) i.e. the ratio of private to public costs was almost 1:1.

Conclusion: Intervention for mild Alzheimer's disease can be undertaken at a relatively low cost to public funds. However, policy planners should pay attention to the significant private costs associated with an intervention, which may ultimately pose a threat to equity in access to health care.

Trial registration: Current Controlled Trials ISRCTN74848736.

Figure 1

Impact of alternative scenarios of the total intervention cost of a multifaceted intervention for patients with mild Alzheimer's disease and their primary caregivers (EUR 2,020 in base-case analysis).

Figure 2

Impact of alternative scenarios of the proportion of private copayment by patients with mild Alzheimer's disease and their primary caregivers attending a multifaceted support programme (0.47 in base-case analysis).