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The European Journal of Health Economics

, Volume 16, Issue 7, pp 689–707 | Cite as

Costs of care for people with dementia just before and after nursing home placement: primary data from eight European countries

  • Ansgar Wübker
  • Sandra M. G. Zwakhalen
  • David Challis
  • Riitta Suhonen
  • Staffan Karlsson
  • Adelaida Zabalegui
  • Maria Soto
  • Kai Saks
  • Dirk Sauerland
Original Paper

Abstract

Background

Dementia is the most common cause of functional decline among elderly people and is associated with high costs of national healthcare in European countries. With increasing functional and cognitive decline, it is likely that many people suffering from dementia will receive institutional care in their lifetime. To delay entry to institutional care, many European countries invest in home and community based care services.

Objectives

This study aimed to compare costs for people with dementia (PwD) at risk for institutionalization receiving professional home care (HC) with cost for PwD recently admitted to institutional long-term nursing care (ILTC) in eight European countries. Special emphasis was placed on differences in cost patterns across settings and countries, on the main predictors of costs and on a comprehensive assessment of costs from a societal perspective.

Methods

Interviews using structured questionnaires were conducted with 2,014 people with dementia and their primary informal caregivers living at home or in an ILTC facility. Costs of care were assessed with the resource utilization in dementia instrument. Dementia severity was measured with the standardized mini mental state examination. ADL dependence was assessed using the Katz index, neuropsychiatric symptoms using the neuropsychiatric inventory (NPI) and comorbidities using the Charlson. Descriptive analysis and multivariate regression models were used to estimate mean costs in both settings. A log link generalized linear model assuming gamma distributed costs was applied to identify the most important cost drivers of dementia care.

Results

In all countries costs for PwD in the HC setting were significantly lower in comparison to ILTC costs. On average ILTC costs amounted to 4,491 Euro per month and were 1.8 fold higher than HC costs (2,491 Euro). The relation of costs between settings ranged from 2.4 (Sweden) to 1.4 (UK). Costs in the ILTC setting were dominated by nursing home costs (on average 94 %). In the HC setting, informal care giving was the most important cost contributor (on average 52 %). In all countries costs in the HC setting increased strongly with disease severity. The most important predictor of cost was ADL independence in all countries, except Spain and France where NPI severity was the most important cost driver. A standard deviation increase in ADL independence translated on average into a cost decrease of about 22 %.

Conclusion

Transition into ILTC seems to increase total costs of dementia care from a societal perspective. The prevention of long-term care placement might be cost reducing for European health systems. However, this conclusion depends on the country, on the valuation method for informal caregiving and on the degree of impairment.

Keywords

Dementia Costs of care Professional home care versus institutional long-term care Informal caregiving International data 

JEL Classification

I10 I11 I18 

Notes

Acknowledgments

The Right Time Place Care study is supported by a grant from the European Commission within the 7th framework program (project 242,153).

References

  1. 1.
    Alzheimer’s Disease International: World Alzheimer Report 2010: The global economic impact of dementia. http://www.alz.co.uk/research/files/WorldAlzheimerReport2010.pdf (2010). Assessed 07/07/2013
  2. 2.
    Hurd, M.D., Martorell, P., Delavande, A., Mullen, K.J., Langa, K.M.: Monetary costs of dementia in the United States. N. Engl. J. Med. 368, 1326–1334 (2013)PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Jönsson, L., Eriksdotter Jönhagen, M., Kilander, L., Soininen, H., Hallikainen, M., Waldemar, G., Nygaad, H., Andreasen, N., Winblad, B., Wimo, A.: Determinants of costs of care for patients with Alzheimerʼs disease. Int. J. Ger. Psych. 21(5), 449–459 (2006)CrossRefGoogle Scholar
  4. 4.
    Quentin, W., Riedel-Heller, S.G., Luppa, M., Rudolph, A., König, H.H.: Cost-of-illness studies of dementia: a systematic review focusing on stage dependency of costs. Acta. Psychiatr. Scand. 121, 243–259 (2010)CrossRefPubMedGoogle Scholar
  5. 5.
    Yaffe, K., Fox, P., Newcomer, R., Sands, L., Lindquist, K., Dane, K., Covinsky, K.: Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA 287(16), 2090–2097 (2002)CrossRefPubMedGoogle Scholar
  6. 6.
    Smith, G.E., Kokmen, E., O´Brian, P.C.: Risk factors for nursing home placement in a population-based dementia cohort. J. Am. Geriatr. Soc. 48, 519–525 (2000)CrossRefPubMedGoogle Scholar
  7. 7.
    Verbeek, H., Meyer, G., Leino-Kilpi, H., Zabalegui, A., Rahm Hallberg, I., Saks, K., Soto, M., Challis, D., Sauerland, D., Hamers, J.: European study investigating patterns of transition from home care towards institutional dementia care: the protocol of a Right Time Place Care study. BMC Public Health 12, 68 (2012)PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Tucker, S., Hughes, J., Burns, A., Challis, D.: The balance of care: reconfiguring services for older people with mental health problems. Aging Ment. Health. 12, 81–91 (2008)CrossRefPubMedGoogle Scholar
  9. 9.
    Feldman, H.H., Pirttila, T., Dartigues, J.F., Everitt, B., Van Baelen, B., Schwalen, S., Kavanagh, S.: Treatment with galantamine and time to nursing home placement in Alzheimer’s disease patients with and without cerebrovascular disease. Int. J. Geriatr. Psychiatry 24, 479–488 (2009)CrossRefPubMedGoogle Scholar
  10. 10.
    Ribbe, M.W., Ljunggren, G., Steel, K., Topinkova, E., Hawes, C., Ikegami, N., Henrard, J.C., Jonnson, P.V.: Nursing homes in 10 nations: a comparison between countries and settings. Age Ageing 26(Suppl. 2), 3–12 (1997)CrossRefPubMedGoogle Scholar
  11. 11.
    Leicht, H., König, H.H., Stuhldreher, N., Bachmann, C., Bickel, H., et al.: Predictors of costs in dementia in a longitudinal perspective. PLoS ONE 8(7), e70018 (2013). doi: 10.1371/journal.pone.0070018.Print PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Leicht, H., Heinrich, S., Heider, D., Bachmann, C., Bickel, H., et al.: Net costs of dementia by disease stage. Acta. Psychiatr. Scand. 124, 384–395 (2011)CrossRefPubMedGoogle Scholar
  13. 13.
    Schwarzkopf, L., Menn, P., Kunz, S., Holle, R., Lauterberg, J., et al.: Costs of care for dementia patients in community setting: an analysis for mild and moderate disease stage. Value Health 14, 827–835 (2011)CrossRefPubMedGoogle Scholar
  14. 14.
    van den Berg, B., Brouwer, W.B.F., Koopmanschap, M.A.: Economic valuation of informal care. An overview of methods and applications. Eur. J. Health Econ. 5, 36–45 (2004)CrossRefPubMedGoogle Scholar
  15. 15.
    Brouwer, W., van Exel, N.J., Koopmanschap, M., Rutten, F.: The valuation of informal care in economic appraisal. Int. J. Technol. Assess. Health Care 15, 147–160 (1999)CrossRefPubMedGoogle Scholar
  16. 16.
    Wimo, A., Wetterholm, A.L., Mastey, V., Winblad, B.: Evaluation of the healthcare resource and caregiver time in anti-dementia drug trials: a quantitative battery. In: Wimo, A., Jönsson, B., Karlsson, G., Winblad, B. (eds.) Health economics of dementia. Wiley, Chichester (1998)Google Scholar
  17. 17.
    Wimo, A., Nordberg, G.: Validity of assessments of time. Comparisons of direct observations and estimates of time by the use of the (Resource Utilisation in Dementia) RUD-instrument. Arch. Gerontol. Geriatr. 44(1), 71–81 (2007)CrossRefPubMedGoogle Scholar
  18. 18.
    Wimo, A., Jonsson, L., Zbrozek, A.: The resource utilization in dementia (RUD) instrument is valid for assessing informal care time in community-living patients with dementia. J. Nutr. Health Aging 14(8), 685–690 (2010)CrossRefPubMedGoogle Scholar
  19. 19.
    Rapp, T., Andrieu, S., Molinier, L., Grand, A., Cantet, C., et al.: Exploring the relationship between Alzheimer’s disease severity and longitudinal costs. Value Health 15, 412–419 (2012)CrossRefPubMedGoogle Scholar
  20. 20.
    Mesterton, J., Wimo, A., Langworth, S., Winblad, B., Jönsson, L.: Cross-sectional observational study on the societal costs of Alzheimer’s disease. Curr. Alzheimer Res. 7(4), 358–367 (2010)CrossRefPubMedGoogle Scholar
  21. 21.
    Gustavsson, A., Johansson, L., Rapp, T., Reynish, E., Ousset, P.J., Andrieu, S., Cantet, C., Winblad, B., Vellas, B., Wimo, A.: Differences in resource use and costs of dementia care between European countries: baseline data from the ICTUS study. J. Nutr. Health Aging 14(8), 648–654 (2010)CrossRefPubMedGoogle Scholar
  22. 22.
    Gustavsson, A., Brinck, P., Bergvall, N., Kolasa, K., Wimo, A., Winblad, B., Jonsson, L.: Predictors of costs of care in Alzheimer’s disease: a multinational sample of 1222 patients. Alzheimers Dement. 7(3), 318–327 (2011)CrossRefPubMedGoogle Scholar
  23. 23.
    Molloy, D.W., Alemayehu, E., Roberts, R.: Reliability of a standardized mini-mental-state-examination compared with the traditional mini-mental-state examination. Am. J. Psychiatry 148(1), 102–105 (1991)CrossRefPubMedGoogle Scholar
  24. 24.
    Katz, S.: Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J. Am. Geriatr. Soc. 31(12), 721–727 (1983)CrossRefPubMedGoogle Scholar
  25. 25.
    Charlson, M.E., Pompei, P., Ales, K.L., MacKenzie, C.R.: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 40(5), 373–383 (1987)CrossRefPubMedGoogle Scholar
  26. 26.
    Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A., Gornbein, J.: The neuropsychiatric inventory. Neurology 44(12), 2308 (1994)CrossRefPubMedGoogle Scholar
  27. 27.
    Zarit, S.H., Reever, K.E., Bach-Peterson, J.: Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist 20(6), 649–655 (1980)CrossRefPubMedGoogle Scholar
  28. 28.
  29. 29.
    de Meijer, C., Brouwer, W., Koopmanschap, M., van den Berg, B., van Exel, J.: The value of informal care–a further investigation of the feasibility of contingent valuation in informal caregivers. Health Econ. 19(7), 755–771 (2010)CrossRefPubMedGoogle Scholar
  30. 30.
    Hakkaart- van Roijen, L., Tan, S.S, Bouwmans, C.A.M.: Handleiding voor kostenonderzoek. Methoden en standaard kostprijzen voor economische evaluaties in de 63 gezondheidszorg. http://www.cvz.nl/binaries/live/cvzinternet/hst_content/nl/documenten/lossepublicaties/handleiding-kostenonderzoek-2010.pdf (2010). Assessed 20/07/2013
  31. 31.
    Curtis, L.: Unit costs of health and social care 2010. (2010), in: http://www.pssru.ac.uk/archive/pdf/uc/uc2010/uc2010.pdf. Assessed 20/07/2013
  32. 32.
    Luttenberger, K., Graessel, E.: Recording care time in nursing homes: development and validation of the “RUD-FOCA” (resource utilization in dementia-formal care). Int. Psychogeriatr. 22, 1291–1300 (2010)CrossRefPubMedGoogle Scholar
  33. 33.
    Fries, B.E., Schneider, D.P., Foley, W.J., Gavazzi, M., Burke, R., Cornelius, E.: Refining a case-mix measure for nursing homes. Resource utilisation groups (RUG-III). Med. Care 32, 668–685 (1994)CrossRefPubMedGoogle Scholar
  34. 34.
    Carpenter, G.I., Perry, M., Challis, D., Hope, K.: Identification of registered nursing care of residents in English nursing homes using the minimum data set resident assessment instrument (MDS/RAI) and resource utilisation groups version III (RUG-III). Age Ageing 32, 279–285 (2003)CrossRefPubMedGoogle Scholar
  35. 35.
    Gustavsson, A., Jönsson, L., Parmler, J., Andreasen, N., Wattmo, C., Wallin, Å.K., Minthon, L.: Disease progression and costs of care in Alzheimerʼs disease patients treated with donepezil: a longitudinal naturalistic cohort. Eur. J. Health Econ. 13(5), 561–568 (2012)CrossRefPubMedGoogle Scholar
  36. 36.
    Zhu, C.W., Scarmeas, N., Torgan, R., Albert, M., Brandt, J., Blacker, D., Sano, M., Stern, Y.: Clinical characteristics and longitudinal changes of informal cost of Alzheimer’s disease in the community. J. Am. Geriatr. Soc. 54, 1596–1602 (2006)PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Murman, D.L., Von Eye, A., Sherwood, P.R., Liang, J., Colenda, C.C.: Evaluated need, costs of care, and payer perspective in degenerative dementia patients cared for in the United States. Alzheimer Dis. Assoc. Disord. 21, 39–48 (2007)CrossRefPubMedGoogle Scholar
  38. 38.
    Verbeek, H., Challis, D., Karlsson, S., Leino-Kilpi, H., Meyer, G., Saks, K., Soto, M., Zabalegui, A., Hamers, J.P.: Factors influencing the institutionalization of people with dementia: a survey in 8 European countries, unpublished manuscript (submitted) (2014)Google Scholar
  39. 39.
    International labour offices (ILO) database. http://laborsta.ilo.org/ (2013). Assessed 07/09/2012
  40. 40.
    OECD: OECD Health Policy Studies. Pharmaceutical pricing policies in a global market.http://www.oecd.org/fr/els/systemes-sante/pharmaceuticalpricingpoliciesinaglobalmarket.htm (2008). Assessed 07/09/2013
  41. 41.
    Ellviva: http://www.ellviva.de/Gesundheit/Medikamente (2013). Assessed 07/09/2012
  42. 42.
    Tan, S., Oostenbrink, J., Rutten, F.: Costs and prices of healthcare services in the Netherlands: a micro costing approach based on case-vignettes.http://www.ehma.org/files/HB%20WP9%20Report%20Netherlands.pdf (2006). Assessed 11/11/2011

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ansgar Wübker
    • 1
    • 2
  • Sandra M. G. Zwakhalen
    • 3
  • David Challis
    • 4
  • Riitta Suhonen
    • 5
  • Staffan Karlsson
    • 6
  • Adelaida Zabalegui
    • 7
  • Maria Soto
    • 8
  • Kai Saks
    • 9
  • Dirk Sauerland
    • 10
  1. 1.University of Witten/HerdeckeEssenGermany
  2. 2.Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Health DevisionEssenGermany
  3. 3.Maastricht UniversityMaastrichtNetherlands
  4. 4.The University of ManchesterManchesterUK
  5. 5.University of Turku, Department of Nursing ScienceTurkuFinland
  6. 6.Lund University, The Swedish Institute of Health SciencesLundSweden
  7. 7.School of Health Sciences, Hospital Clínic de BarcelonaMataró (Barcelona)Spain
  8. 8.Gérontopôle de Toulouse, Department of Geriatric MedicineUniversity Hospital de ToulouseToulouseFrance
  9. 9.University of Tartu, Department of Internal MedicineTartuEstonia
  10. 10.University of Witten/Herdecke, Department of Institutional Economics and Health Systems ManagementWittenGermany

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