The journal of nutrition, health & aging

, Volume 14, Issue 8, pp 655–663 | Cite as

Alzheimer's disease: The strength of association of costs with different measures of disease severity

JNHA: Clinical Neurosciences

Abstract

Objective

To identify Alzheimer's disease (AD) severity measures for use in cost-effectiveness models that effectively capture the impact of AD on costs.

Methods

A review of the literature and data abstraction from papers that present 1) mean AD costs (direct, indirect, or total) by disease severity, defined using measure of cognition, functional status, and behavior; and/or 2) the results of regression analyses that estimate the strength of the association between AD costs and disease severity.

Results

All papers reviewed showed that mean total costs increase with disease severity regardless of severity-measurement method. The relative difference in mean total costs between patients with severe disease compared to those with moderate disease, or moderate disease compared to mild disease, was fairly consistent across studies, suggesting that any of the disease-severity measures may be used to broadly categorize patients by cost. However, when regression analysis included multiple disease-severity measures, independent associations with costs were noted for the different measures. Cognitive and functional status measures were consistently associated with direct costs, whereas functional status and behavioral measures were consistently associated with indirect costs and caregiver hours.

Conclusions

Either multidimensional disease-severity measures, or a single disease-severity measure, that capture the impact of cognition, functional status, and behavior on costs are needed for cost-effectiveness models.

Key words

Alzheimer's disease disease severity cognition functional status behavior costs 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Zhu CW, Sano M: Economic considerations in the management of Alzheimer's disease. Clin Interv Aging 2006, 1(2): 143–154.CrossRefPubMedGoogle Scholar
  2. 2.
    Hope T, Keene J, Fairburn CG, Jacoby R, McShane R: Natural history of behavioural changes and psychiatric symptoms in Alzheimer's disease. A longitudinal study. Br J Psychiatry 1999, 174: 39–44.CrossRefPubMedGoogle Scholar
  3. 3.
    Neumann PJ, Hermann RC, Kuntz KM, Araki SS, Duff SB, Leon J, Berenbaum PA, Goldman PA, Williams MS, and Weinstein MC: Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease. Neurology 1999, 52(6): 1138–1145.PubMedGoogle Scholar
  4. 4.
    O'Brien BJ, Goeree R, Hux M, Iskedjian M, Blackhouse G, Gagnon M: Economic evaluation of donepezil for the treatment of Alzheimer's disease in Canada. J Am Geriatr Soc 1999, 47(5): 570–578.PubMedGoogle Scholar
  5. 5.
    Fagnani F, Lafuma A, Pechevis M, Rigaud AS, Traykov L, Seux ML, Forette F: Donepezil for the treatment of mild to moderate Alzheimer's disease in France: the economic implications. Dement Geriatr Cogn Disord 2004, 17(1–2): 5–13. E-pub 2003 Oct 13.CrossRefPubMedGoogle Scholar
  6. 6.
    Fenn P, Gray A: Estimating the long term cost savings from treatment of Alzheimer's disease: a modeling approach. Pharmacoeconomics 1999, (2): 165–174.Google Scholar
  7. 7.
    Hauber AB, Gnanasakthy A, Snyder EH, Bala MV, Richter A, Mauskopf JA: Potential savings in the cost of caring for patients with Alzheimer's disease: treatment with rivastigmine. Pharmacoeconomics 2000, 17(4): 351–360.CrossRefPubMedGoogle Scholar
  8. 8.
    Weycker D, Taneja C, Edelsberg J, Erder MH, Schmitt FA, Setyawan J, Oster G: Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil. Curr Med Res Opin 2007, 23(5): 1187–1197.CrossRefPubMedGoogle Scholar
  9. 9.
    Caro JJ, Getsios D, Migliaccio-Walle K, Raggio G, Ward A, the AHEAD Study Group: Assessment of health economics in Alzheimer's disease (AHEAD) based on need for full-time care. Neurology 2001, 57(6): 964–971.PubMedGoogle Scholar
  10. 10.
    Caro JJ, Salas M, Ward A, Getsios D, Mehnert A, the AHEAD Study Group: Assessment of health economics in Alzheimer's Disease. Economic analysis of galantamine, a cholinesterase inhibitor, in the treatment of patients with mild to moderate Alzheimer's disease in the Netherlands. Dement Geriatr Cogn Disord 2002, 14(2): 84–89.CrossRefPubMedGoogle Scholar
  11. 11.
    Caro J, Getsios D, Migliaccio-Walle K, Ishak J, El-Hadi W, the AHEAD Study Group: Rational choice of cholinesterase inhibitor for the treatment of Alzheimer's disease in Canada: a comparative economic analysis. BMC Geriatr 2003, 3:6.CrossRefPubMedGoogle Scholar
  12. 12.
    Green C, Picot J, Loveman E, Takeda A, Kirby J, Clegg A: Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer's disease. Pharmacoeconomics 2005, 23(12): 1271–1282.CrossRefPubMedGoogle Scholar
  13. 13.
    François C, Sintonen H, Sulkava R, Rive B: Cost effectiveness of memantine in moderately severe to severe Alzheimer's disease: a Markov model in Finland. Clin Drug Investig 2004, 24(7): 373–384.CrossRefPubMedGoogle Scholar
  14. 14.
    Jönes RW, McCrone P, Guilhaume C: Cost effectiveness of memantine in Alzheimer's disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging 2004, 21(9): 607–620.CrossRefPubMedGoogle Scholar
  15. 15.
    Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, Clegg, A: The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technol Assess 2006, 10(1): iii–iv; ix–xi; 1–160.PubMedGoogle Scholar
  16. 16.
    Birks J: Cholinesterase inhibitors for Alzheimer's disease [review]. Cochrane Database System Rev 2006, 1. Art. No. CD005593. DOI: 10.1002/14651858.CD005593.Google Scholar
  17. 17.
    Raina P, Santaguida P, Ismaila A, Patterson C, Cowan D, Levine M, Booker L, Oremus M: Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Ann Intern Med 2008, 148(5): 379–397.PubMedGoogle Scholar
  18. 18.
    Cortes F, Gillette-Guyonnet S, Nourhashemi F, Christelle C, Vellas B: Family history of dementia does not influence the progression of Alzheimer's disease at two years: results from the REAL. FR Study. Am J Alzheimers Dis Other Demen 2006, 21(2): 131–136.CrossRefPubMedGoogle Scholar
  19. 19.
    Behl P, Stefurak TL, Black SE: Progress in clinical neurosciences: cognitive markers of progression in Alzheimer's disease. Can J Neurol Sci 2005, 32(2): 140–151.PubMedGoogle Scholar
  20. 20.
    Bianchetti A, Frisoni GB, Ghisia KM, Trabucchi M: Clinical predictors of the indirect costs of Alzheimer's disease. Arch Neurol 1998, 55: 130–131.CrossRefPubMedGoogle Scholar
  21. 21.
    Boada M, Pena-Casanova J, Bermejo F, Guillén F, Hart WM, Espinosa C, Rovira J: Costs of health care resources of ambulatory care patients diagnosed with Alzheimer's disease in Spain. Med Clin (Barc) 1999,113: 690–695.Google Scholar
  22. 22.
    Herrmann N, Lanctôt KL, Sambrook R, Lesnikova N, Hébert R, McCracken P, Robillard A, Nguyen E: The contribution of neuropsychiatric symptoms to the cost of dementia care. Int J Geriatr Psychiatry 2006, 21(10): 972–976.CrossRefPubMedGoogle Scholar
  23. 23.
    Hill J, Fillit H, Thomas SK, Chang S: Functional impairment, healthcare costs and the prevalence of institutionalization in patients with Alzheimer's disease and other dementias. Pharmacoeconomics 2006, 24(3): 265–280.CrossRefPubMedGoogle Scholar
  24. 24.
    Hux MJ, O'Brien BJ, Iskedjian M, Goeree R, Gagnon M, Gauthier S: Relation between severity of Alzheimer's disease and costs of caring. Can Med Assoc J 1998, 159: 457–465.Google Scholar
  25. 25.
    Jönsson L, Lindgren P, Wimo A, Jönsson B, Winblad, B: Costs of Mini-Mental State Examination-related cognitive impairment. Pharmacoeconomics 1999, 16: 409–416.CrossRefPubMedGoogle Scholar
  26. 26.
    Jönsson L, Jönhagen ME, Kilander L, Soininen H, Hallikainen M, Waldemar G, Nygaard H, Andreasen N, Winblad B, Wimo A: Determinants of costs of care for patients with Alzheimer's disease. Int J Geriatr Psychiatry 2006, 21: 449–459.CrossRefPubMedGoogle Scholar
  27. 27.
    Kang IO, Lee SY, Kim SY, Park CY. Economic cost of dementia patients according to the limitation of the activities of daily living in Korea. Int J Geriatr Psychiatry 2007, 22: 675–681.CrossRefPubMedGoogle Scholar
  28. 28.
    Kavanagh S, Knapp M: Cognitive disability and direct care costs for elderly people. Br J Psychiatry 1999, 174: S39–S46.CrossRefGoogle Scholar
  29. 29.
    Kavanagh S, Knapp M: Costs and cognitive disability: modeling the underlying associations. Br J Psychiatry 2002, 180: 120–125.CrossRefPubMedGoogle Scholar
  30. 30.
    Kronborg-Andersen C, Segard J, Hansen E, Kragh-Søensen A, Hastrup L, Andersen J, Andersen K, Lolk A, Nielsen H, Kragh-Søensen P: The cost of dementia in Denmark: the Odense study. Dement Geriatr Cogn Disord 1999, 10: 295–304.CrossRefPubMedGoogle Scholar
  31. 31.
    Kronborg-Andersen C, Lauridsen J, Andersen K, Kragh-Sorensen P: Cost of dementia: impact of disease progression estimated in longitudinal data. Scand J Public Health 2003, 31: 119–125.CrossRefGoogle Scholar
  32. 32.
    Langa KM, Chernew ME, Kabeto MU, Regula Herzog AR, Ofstedal MB, Willis RJ, Wallace RB, Mucha LM, Straus WL, Fendrick AM: National estimates of the quantity and cost of informal caregiving for the elderly with dementia. J Gen Intern Med 2001, 16: 770–778.CrossRefPubMedGoogle Scholar
  33. 33.
    Leon J, Neumann PJ: The cost of Alzheimer's disease in managed care: a crosssectional study. Am J Manag Care 1999, 5: 867–877.PubMedGoogle Scholar
  34. 34.
    Livingston G, Katona C, Roch B, Guilhaume C, Rive B: A dependency model for patients with Alzheimer's disease: its validation and relationship to the costs of care-the LASER-AD study. Curr Med Res Opin 2004, 20: 1007–1016.CrossRefPubMedGoogle Scholar
  35. 35.
    López-Pousa S, Garre-Olmo J, Turon-Estrada A, Hernández F, Expósito I, Lozano-Gallego M, Hernández-Ferrándiz M, Gelada-Batlle E, Pericot-Nierga I, Vilalta-Franch J: Cost relation between severity of Alzheimer's disease and cognitive and functional impairment. Med Clin (Barc) 2004, 122: 767–772.CrossRefGoogle Scholar
  36. 36.
    Moore MJ, Zhu CW, Clipp EC: Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study. J Gerontol B Psychol Sci Soc Sci 2001, 56: S219–S228.PubMedGoogle Scholar
  37. 37.
    Murman DL, Chen Q, Powell MC, Kuo SB, Bradley CJ, Colenda CC: The incremental direct costs associated with behavioral symptoms in AD. Neurology 2002, 59: 1721–1729.CrossRefPubMedGoogle Scholar
  38. 38.
    Neubauer S, Holle R, Menn P, Grossfeld-Schmitz M, Graesel E: Measurement of informal care time in a study of patients with dementia. Int Psychogeriatrics 2008, 20: 1160–1176.CrossRefGoogle Scholar
  39. 39.
    Nordberg G, Wimo A, Jönsson L, Sjölund B-M, Lagergren M, von Strauss E: Time use and costs of institutionalized elderly person with or without dementia: results from the Nordanstig cohort in the Kungsholmen Project- a population based study in Sweden. Int J Geriatr Psychiatry 2007, 22: 639–648.CrossRefPubMedGoogle Scholar
  40. 40.
    Rice DP, Fox PJ, Max W, Webber PA, Lindeman DA, Hauck WW, Segura E: The economic burden of Alzheimer's disease care. Health Aff (Millwood) 1993, 12(2): 164–176.CrossRefGoogle Scholar
  41. 41.
    Rigaud AS, Fagnani F, Bayle C, Latour F, Traykov L, Forette F: Patients with Alzheimer's disease living at home in France: costs and consequences of the disease. J Geriatri Psychiatry Neurol 2003, 16: 140–145.CrossRefGoogle Scholar
  42. 42.
    Small GW, McDonnell DD, Brooks RL, Papadopoulos G: The impact of symptom severity on the cost of Alzheimer's disease. J Am Geriatr Soc 2002, 50(2): 321–327.CrossRefPubMedGoogle Scholar
  43. 43.
    Souetre E, Thwaites RM, Yeardley HL: Economic impact of Alzheimer's disease in the United Kingdom. Cost of care and disease severity for non-institutionalised patients with Alzheimer's disease. Br J Psychiatry 1999, 174: 51–55.CrossRefPubMedGoogle Scholar
  44. 44.
    Taylor DH, Schenkman M, Zhou J, Sloan FA: The relative effect of Alzheimer's disease and related dementias, disability, and comorbidities on cost of care for elderly persons. J Gerontol 2001, 56B: S285–S293.Google Scholar
  45. 45.
    Wimo A, von Strauss E, Nordberg G, Sassi F, Johansson L: Time spent on informal and formal care giving for persons with dementia in Sweden. Health Policy 2002, 61: 255–268.CrossRefPubMedGoogle Scholar
  46. 46.
    Wolstenholme J, Fenn P, Gray A, Keene J, Jacoby R, Hope T: Estimating the relationship between disease progression and cost of care in dementia. Br J Psychiatry 2002, 181: 36–42.CrossRefPubMedGoogle Scholar
  47. 47.
    Zhu CW, Scarmeas N, Torgan R, Albert M, Brandt J, Blacker D, Sano M, Stern Y: Longitudinal study of the effects of patient characteristics on direct costs in Alzheimer's disease. Neurology 2006, 67: 998–1005.CrossRefPubMedGoogle Scholar
  48. 48.
    Zhu CW, Leibman C, McLaughlin T, Zbrozek AS, Scarmeas N, Albert M, Brandt J, Blacker D, Sano M, Stern Y: Patient dependence and longitudinal changes in costs of care in Alzheimer's disease. Dement Geriatr Cogn Disord 2008, 26: 416–423.CrossRefPubMedGoogle Scholar
  49. 49.
    Jönsson L, Wimo A: The costs of dementia in Europe. Pharmacoeconomics 2008, 27: 391–403.CrossRefGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2010

Authors and Affiliations

  1. 1.RTI Health SolutionsResearch Triangle ParkUSA
  2. 2.Pfizer Inc.CollegevilleUSA

Personalised recommendations