Economic Evaluation of Healthcare Resource Utilization and Costs for Newly Diagnosed Dementia-Related Psychosis

Abstract

This retrospective cohort study described changes in all-cause healthcare resource utilization (HCRU) and associated costs in dementia patients newly diagnosed with psychosis. Dementia and incident psychosis were identified using diagnostic and pharmacy claims using a Medicare 20% random sample dataset. All-cause HCRU and unweighted and weighted (by person-years of follow-up) HCRU-associated costs were evaluated in the year prior to and the 4 years following diagnosis of psychosis. In 49,509 dementia patients with psychosis, physician visits per patient per year increased from a mean of 26.7 (standard deviation (SD) 20.0) prior to psychosis to 38.4 (SD 41.9) post-psychosis diagnosis. The number of inpatient stay claims increased from 1.0 (SD 1.4) to 1.7 (SD 5.8). Mean unweighted costs for inpatient stays and home healthcare/hospice during 2008-2016 were USD 9989 and USD 3279 prior to a diagnosis of psychosis but increased to USD 25,982 and USD 9901 (weighted: USD 11,779 and USD 6709), respectively, in the year after a psychosis diagnosis. This pattern of a sharp increase in mean costs was also observed in costs adjusted to 2015 USD, and in both unweighted and weighted total and psychosis-related costs. These results indicate the importance of identifying newly diagnosed psychosis in dementia patients as well as the pressing need for management strategies and treatments that can reduce HCRU and costs.

Keywords: Medicare; delusions; dementia; economic burden; hallucinations; psychosis.

Figure 1

Annualized unweighted all-cause costs per patient per year by type of Medicare setting adjusted to 2015 USD. LTC and Medicare costs may not sum to total row costs due to rounding. Abbreviations: DME = durable medical equipment; LTC = long-term care; SNF = skilled nursing facility.

Figure 2

Annualized unweighted all-cause costs per patient per year overall in Medicare and LTC in 2015 USD. Abbreviation: LTC = long-term care.

Figure 3

Annualized unweighted psychosis-related costs per patient per year by type of Medicare Setting in 2015 USD. LTC and Medicare costs may not sum to total row costs due to rounding. Abbreviations: DME = durable medical equipment; LTC = long-term care; SNF = skilled nursing facility.