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Comparative Study
. 2019 Apr;20(3):343-355.
doi: 10.1007/s10198-018-1001-3. Epub 2018 Sep 3.

Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer's disease dementia

Mark Belger  1 , Josep Maria Haro  2 , Catherine Reed  3 , Michael Happich  3 , Josep Maria Argimon  4 , Giuseppe Bruno  5 , Richard Dodel  6 , Roy W Jones  7 , Bruno Vellas  8 , Anders Wimo  9   10
Affiliations
Comparative Study

Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer's disease dementia

Mark Belger et al. Eur J Health Econ. 2019 Apr.

Abstract

Objectives: To examine the costs of caring for community-dwelling patients with Alzheimer's disease (AD) dementia in relation to the time to institutionalisation.

Methods: GERAS was a prospective, non-interventional cohort study in community-dwelling patients with AD dementia and their caregivers in three European countries. Using identified factors associated with time to institutionalisation, models were developed to estimate the time to institutionalisation for all patients. Estimates of monthly total societal costs, patient healthcare costs and total patient costs (healthcare and social care together) prior to institutionalisation were developed as a function of the time to institutionalisation.

Results: Of the 1495 patients assessed at baseline, 307 (20.5%) were institutionalised over 36 months. Disease severity at baseline [based on Mini-Mental State Examination (MMSE) scores] was associated with risk of being institutionalised during follow up (p < 0.001). Having a non-spousal informal caregiver was associated with a faster time to institutionalisation (944 fewer days versus having a spousal caregiver), as was each one-point worsening in baseline score of MMSE, instrumental activities of daily living and behavioural disturbance (67, 50 and 30 fewer days, respectively). Total societal costs, total patient costs and, to a lesser extent, patient healthcare-only costs were associated with time to institutionalisation. In the 5 years pre-institutionalisation, monthly total societal costs increased by more than £1000 (€1166 equivalent for 2010) from £1900 to £3160 and monthly total patient costs almost doubled from £770 to £1529.

Conclusions: Total societal costs and total patient costs rise steeply as community-dwelling patients with AD dementia approach institutionalisation.

Keywords: Alzheimer’s disease; Caregiver; Institutionalisation; Predictors; Societal costs.

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Conflict of interest statement

Conflict of interest

MB, CR and MH are employees and shareholders of Eli Lilly and Company. JMH, JMA, GB, RD, RWJ, BV and AW have received financial compensation from Eli Lilly for participation in the GERAS Advisory Board. JMH has received financial compensation from Otsuka, Roche and Lundbeck for participation in advisory boards. RD has received research funding, honoraria and financial compensation for consultancy or advisory board membership from a number of pharmaceutical companies including Abbott/AbbVie, Baxter, Eli Lilly, Novartis, Octapharma and Pfizer and from some medical societies. RWJ has received honoraria for speaking at/chairing symposia and has been a member of advisory boards for Eli Lilly. AW has received financial compensation from Lundbeck, Novartis, Biogen and Roche for participation in advisory boards.

Informed consent

The GERAS study was approved by ethical review boards in accordance with country-specific regulations. Written informed consent was obtained from all participants or their legal representative.

Figures

Fig. 1
Fig. 1
Cumulative incidence of institutionalisation over 36 months by AD dementia severity at baseline. *p < 0.001 for comparison across groups with mild, moderate and MS/S AD dementia (Wald test). AD Alzheimer’s disease, CL confidence limits, MS/S moderately severe/severe
Fig. 2
Fig. 2
Extrapolation plots of time to institutionalisation beyond 36 months for the different model distributions examined in models of the 36-month data that included patient and caregiver factors. Data cut-off = 9125 days (25 years). AIC Akaike Information Criterion, BIC Bayesian Information Criterion
Fig. 3
Fig. 3
Estimated monthly total societal costs, total patient costs and patient healthcare costs by time to institutionalisation (years)
See this image and copyright information in PMC

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