Medical Care and Long-Term Care Expenditures Attributable to Alzheimer's Disease Onset: Results from the LIFE Study

Abstract

Background: Alzheimer's disease (AD) can increase both medical care and long-term care (LTC) costs, but the latter are frequently neglected in estimates of AD's economic burden.

Objective: To elucidate the economic burden of new AD cases in Japan by estimating patient-level medical care and LTC expenditures over 3 years using a longitudinal database.

Methods: The study was performed using monthly claims data from residents of 6 municipalities in Japan. We identified patients with new AD diagnoses between April 2015 and March 2016 with 3 years of follow-up data. Medical care and LTC expenditures were estimated from 1 year before onset until 3 years after onset. To quantify the additional AD-attributable expenditures, AD patients were matched with non-AD controls using propensity scores, and their differences in expenditures were calculated.

Results: After propensity score matching, the AD group and non-AD group each comprised 1748 individuals for analysis (AD group: mean age±standard deviation, 81.9±7.6 years; women, 66.0%). The total additional expenditures peaked at $1398 in the first month, followed by $1192 and $1031 in the second and third months, respectively. The additional LTC expenditures increased substantially 3 months after AD onset ($227), and gradually increased thereafter. These additional LTC expenditures eventually exceeded the additional medical care expenditures in the second year after AD onset.

Conclusion: Although total AD-attributable expenditures peaked just after disease onset, the impact of LTC on these expenditures rose over time. Failure to include LTC expenditures would severely underestimate the economic burden of AD.

Keywords: Alzheimer’s disease; dementia; health expenditures; healthcare administrative claims; long-term care.

Fig. 1

Trends in monthly expenditures in Alzheimer’s disease (AD) patients and non-AD controls. The graphs show the monthly (A) medical care expenditures and (B) long-term care expenditures from 12 months before and 36 months after the index month. The black bars indicate the expenditures for AD patients and the gray bars indicate the expenditures for non-AD controls. The dashed line indicates the index month in which an AD patient was newly diagnosed with AD. Each non-AD control used the same index month as their matched AD patient.

Fig. 2

Trends in monthly additional expenditures attributable to Alzheimer’s disease (AD) in AD patients. The graphs show the monthly additional (A) medical care expenditures, (B) long-term care expenditures, and (C) medical care and long-term care expenditures in AD patients from 12 months before and 36 months after the index month. Month 1 indicates the index month in which an AD patient was newly diagnosed with AD.

Fig. 3

Breakdown of monthly expenditures according to cost component in Alzheimer’s disease (AD) patients. The graphs show the breakdown of monthly (A) medical care expenditures and (B) long-term care expenditures according to cost component in AD patients from 12 months before and 36 months after the index month. Month 1 indicates the index month in which an AD patient was newly diagnosed with AD.