PharmacoEconomics

, Volume 27, Issue 5, pp 391–403 | Cite as

The Cost of Dementia in Europe

A Review of the Evidence, and Methodological Considerations
Review Article

Abstract

Alzheimer’s disease (AD) is a leading cause of disability in the elderly, leading to a high burden on caregivers and costs to society. This article describes the current level of data availability regarding the costs of AD in Europe, summarizes and compares findings from previous studies in different countries, and discusses the applicability of available data for modelling purposes.

A literature review was conducted for papers in any language reporting data on costs of care for patients with diagnosed dementia or possible/probable AD. Only papers reporting patient-level data on costs were included. A total of 16 studies were identified: from the Nordic region (4), the UK (3), Spain (3), France (2), Italy (2), Belgium (1) and Germany (1). There is large variation in total cost estimates, depending on, for example, differences in study methodology, setting, type and severity of patients included, range of costs assessed and the choice of principle for valuing informal care. The median value for total annual care costs in all studies was €28 000 (range €6614–€64 426) [year 2005 values]. Few studies assessed aspects of disease severity other than cognitive function.

The costs of AD in Europe are substantial and increase with disease severity. Methodological differences between studies make comparison across countries and healthcare systems difficult, and there is a need to standardize methods for assessing and valuing informal care. Patient-level information on resource use is required to analyse determinants of care costs and predict the impact of therapeutic interventions. More data are needed to support future economic evaluations of therapies for AD.

Supplementary material

40273_2012_27050391_MOESM1_ESM.pdf (101 kb)
Supplementary material, approximately 103 KB.

References

  1. 1.
    Andlin-Sobocki P, Jönsson B, Wittchen HU, et al. Cost of disorders of the brain in Europe. Eur J Neurol 2005; 12 Suppl. 1: 1–27PubMedCrossRefGoogle Scholar
  2. 2.
    Wimo A, Jönsson L, Winblad B. An estimate of the worldwide prevalence and direct costs of dementia in 2003. Dement Geriatr Cogn Disord 2006; 21 (3): 175–81PubMedCrossRefGoogle Scholar
  3. 3.
    Fratiglioni L, Launer LJ, Andersen K, et al. Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000; 54 (11 Suppl. 5): S10–5Google Scholar
  4. 4.
    Klafki HW, Staufenbiel M, Kornhuber J, et al. Therapeutic approaches to Alzheimer’s disease. Brain 2006; 129 (Pt 11): 2840–55PubMedCrossRefGoogle Scholar
  5. 5.
    Wimo A, Jönsson L. Societal costs of dementia [in Swedish]. Stockholm: Socialstyrelsen, 2000Google Scholar
  6. 6.
    Green C. Modelling disease progression in Alzheimer’s disease: a review of modelling methods used for cost-effectiveness analysis. Pharmacoeconomics 2007; 25 (9): 735–50PubMedCrossRefGoogle Scholar
  7. 7.
    Jönsson L. Pharmacoeconomics of cholinesterase inhibitors in the treatment of Alzheimer’s disease. Pharmacoeconomics 2003; 21 (14): 1025–37PubMedCrossRefGoogle Scholar
  8. 8.
    Jönsson L, Eriksdotter Jönhagen M, Kilander L, et al. Determinants of costs of care for patients with Alzheimer’s disease. Int J Ger Psych 2006 May; 21 (5): 449–59CrossRefGoogle Scholar
  9. 9.
    Jönsson L, Berr C. Cost of dementia in Europe. Eur J Neurol 2005; 12 Suppl. 1: 50–3PubMedCrossRefGoogle Scholar
  10. 10.
    Scuvee-Moreau J, Kurz X, Dresse A. The economic impact of dementia in Belgium: results of the National Dementia Economic Study (NADES). Acta Neurol Belg 2002; 102 (3): 104–13PubMedGoogle Scholar
  11. 11.
    Souêtre EJ, Qing W, Vigoureux I, et al. Economic analysis of Alzheimer’s disease in outpatients: impact of symptom severity. Int Psychogeriatr 1995; 7 (1): 115–22PubMedCrossRefGoogle Scholar
  12. 12.
    Rigaud AS, Fagnani F, Bayle C, et al. Patients with Alzheimer’s disease living at home in France: costs and consequences of the disease. J Geriatr Psychiatry Neurol 2003; 16 (3): 140–5PubMedCrossRefGoogle Scholar
  13. 13.
    Cavallo MC, Fattore G. The economic and social burden of Alzheimer disease on families in the Lombardy region of Italy. Alzheimer Dis Assoc Disord 1997; 11 (4): 184–90PubMedGoogle Scholar
  14. 14.
    Trabucchi M. An economic perspective on Alzheimer’s disease. J Geriatr Psychiatry Neurol 1999; 12 (1): 29–38PubMedCrossRefGoogle Scholar
  15. 15.
    Kronborg Andersen C, Søgaard J, Hansen E, et al. The cost of dementia in Denmark: the Odense Study. Dement Geriatr Cogn Disord 1999; 10 (4): 295–304PubMedCrossRefGoogle Scholar
  16. 16.
    Atance Martinez JC, Yusta Izquierdo A, Grupeli Gardel BE. Costs study in Alzheimer’s disease [in Spanish]. Rev Clin Esp 2004; 204 (2): 64–9PubMedCrossRefGoogle Scholar
  17. 17.
    Boada M, Peña-Casanova J, Bermejo F, et al. Costs of health care resources of ambulatory-care patients diagnosed with Alzheimer’s disease in Spain [in Spanish]. Med Clin (Barc) 1999; 113 (18): 690–5Google Scholar
  18. 18.
    Lopez-Bastida J, Serrano-Aguilar P, Perestelo-Perez L, et al. Social-economic costs and quality of life of Alzheimer disease in the Canary Islands, Spain. Neurology 2006; 67 (12): 2186–91PubMedCrossRefGoogle Scholar
  19. 19.
    Souêtre 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: 51–5PubMedCrossRefGoogle Scholar
  20. 20.
    Wolstenholme J, Fenn P, Gray A, et al. Estimating the relationship between disease progression and cost of care in dementia. Br J Psychiatry 2002; 181: 36–42PubMedCrossRefGoogle Scholar
  21. 21.
    Livingston G, Katona C, Roch B, et al. 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 (7): 1007–16PubMedCrossRefGoogle Scholar
  22. 22.
    Schulenberg J, Schulenberg I, Horn R. Cost of treatment and cost of care for Alzheimer’s disease in Germany. In: Wimo A, Jönsson B, Karlsson G, et al., editor. The health economics of dementia. Chichester: John Wiley & Sons, 1998: 217–30Google Scholar
  23. 23.
    Plosker GL, Lyseng-Williamson KA. Memantine: a pharmacoeconomic review of its use in moderate-to-severe Alzheimer’s disease. Pharmacoeconomics 2005; 23 (2): 193–206PubMedCrossRefGoogle Scholar
  24. 24.
    HEED: Health Economics Evaluations Database. London: Office of Health Economics, 2005. (Data on file)Google Scholar
  25. 25.
    Jones 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): 607–20PubMedCrossRefGoogle Scholar
  26. 26.
    Jönsson L. Cost-effectiveness of memantine for moderate to severe Alzheimer’s disease in Sweden. Am J Geriatr Pharmacother 2005; 3 (2): 77–86PubMedCrossRefGoogle Scholar
  27. 27.
    Jönsson L, Lindgren P, Wimo A, et al. The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer’s disease: a Markov model. Clin Ther 1999; 21 (7): 1230–40PubMedCrossRefGoogle Scholar
  28. 28.
    Francois C, Sintonen H, Sulkava R, et al. Cost effectiveness of memantine in moderately severe to severe Alzheimer’s disease: a Markov model in Finland. Clin Drug Invest 2004; 24 (7): 373–84CrossRefGoogle Scholar
  29. 29.
    Rahkonen T, Eloniemi-Sulkava U, Rissanen S, et al. Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older. J Neurol Neurosurg Psychiatry 2003; 74 (6): 720–4PubMedCrossRefGoogle Scholar
  30. 30.
    Fratiglioni L, Viitanen M, Bäckman L, et al. Occurrence of dementia in advanced age: the study design of the Kungsholmen Project. Neuroepidemiology 1992; 11 Suppl. 1: 29–36PubMedCrossRefGoogle Scholar
  31. 31.
    Feldman H, Gauthier S, Hecker J, et al. Economic evaluation of donepezil in moderate to severe Alzheimer disease. Neurology 2004; 63 (4): 644–50PubMedCrossRefGoogle Scholar
  32. 32.
    Wimo A, Winblad B, Stoffler A, et al. Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer’s disease. Pharmacoeconomics 2003; 21 (5): 327–40PubMedCrossRefGoogle Scholar
  33. 33.
    Courtney C, Farrell D, Gray R, et al. Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomised double-blind trial. Lancet 2004; 363 (9427): 2105–15PubMedCrossRefGoogle Scholar
  34. 34.
    Wimo A, Winblad B, Engedal K, et al. An economic evaluation of donepezil in mild to moderate Alzheimer’s disease: results of a 1-year, double-blind, randomized trial. ement Geriatr Cogn Disord 2003; 15 (1) 44–54CrossRefGoogle Scholar
  35. 35.
    Data on file, OECD.Stat database, OECD, 2006Google Scholar
  36. 36.
    Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12 (3): 189–98PubMedCrossRefGoogle Scholar
  37. 37.
    Andersen CK, Lauridsen J, Andersen K, et al. Cost of dementia: impact of disease progression estimated in longitudinal data. Scand J Public Health 2003; 31 (2): 119–25PubMedCrossRefGoogle Scholar
  38. 38.
    Jönsson L, Lindgren P, Wimo A, et al. Costs of MMSE-related cognitive impairment. Pharmacoeconomics 1999; 16 (4): 409–16PubMedCrossRefGoogle Scholar
  39. 39.
    Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Mol State Med J 1965 Feb; 14: 61–5Google Scholar
  40. 40.
    McDaid D. Estimating the costs of informal care for people with Alzheimer’s disease: methodological and practical challenges. Int J Geriatr Psychiatry 2001; 16 (4): 400–5PubMedCrossRefGoogle Scholar
  41. 41.
    Nordberg G, Wimo A, Jönsson L, et al. Time use and costs of institutionalised elderly persons with or without dementia: results from the Nordanstig cohort in the Kungsholmen Project. A population based study in Sweden. Int J Geriatr Psychiatry 2007 Jul; 22 (7): 639–48PubMedCrossRefGoogle Scholar
  42. 42.
    Kirk A. Target symptoms and outcome measures: cognition. Can J Neurol Sci 2007 Mar; 34 (Suppl. 1): S42–6Google Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  1. 1.i3 InnovusStockholmSweden
  2. 2.NVSKarolinska InstituteStockholmSweden

Personalised recommendations