The costs of dementia from the societal perspective: is care provided in the community really cheaper than nursing home care?

Abstract

Objective: To compare the costs of care for community-dwelling dementia patients with the costs of care for dementia patients living in nursing homes from the societal perspective.

Design: Cross-sectional bottom-up cost of illness study nested within the multicenter German AgeCoDe-cohort.

Setting: Community and nursing homes.

Participants: One hundred twenty-eight community-dwelling dementia patients and 48 dementia patients living in nursing homes.

Intervention: None.

Measurements: Utilization and costs of medical care and long term care, including formal and informal social and nursing care based on proxy interviews. Informal care was valued using the replacement cost method.

Results: Unadjusted mean annual total costs including informal care were €29,930 ($43,997) for community-dwelling patients and €33,482 ($49,218) for patients living in nursing homes. However, multiple regression analysis controlling for age, sex, deficits in basic and instrumental activities of daily living and comorbidity showed that living in the community significantly increased total costs by €11,344 ($16,676; P < .01) compared with living in a nursing home, mainly due to higher costs of informal care (+€20,585; +$30,260; P < .001).

Conclusion: From the societal perspective care for dementia patients living in the community tends to cost more than care in nursing homes when functional impairment is controlled for.

Keywords: Cost-of-illness; dementia; informal care; nursing home.