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The European Journal of Health Economics

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Open Access 01-04-2019 | Original Paper

Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer’s disease dementia

Authors: Mark Belger, Josep Maria Haro, Catherine Reed, Michael Happich, Josep Maria Argimon, Giuseppe Bruno, Richard Dodel, Roy W. Jones, Bruno Vellas, Anders Wimo

Published in: The European Journal of Health Economics | Issue 3/2019

Abstract

Objectives

To examine the costs of caring for community-dwelling patients with Alzheimer’s disease (AD) dementia in relation to the time to institutionalisation.

Methods

GERAS was a prospective, non-interventional cohort study in community-dwelling patients with AD dementia and their caregivers in three European countries. Using identified factors associated with time to institutionalisation, models were developed to estimate the time to institutionalisation for all patients. Estimates of monthly total societal costs, patient healthcare costs and total patient costs (healthcare and social care together) prior to institutionalisation were developed as a function of the time to institutionalisation.

Results

Of the 1495 patients assessed at baseline, 307 (20.5%) were institutionalised over 36 months. Disease severity at baseline [based on Mini-Mental State Examination (MMSE) scores] was associated with risk of being institutionalised during follow up (p < 0.001). Having a non-spousal informal caregiver was associated with a faster time to institutionalisation (944 fewer days versus having a spousal caregiver), as was each one-point worsening in baseline score of MMSE, instrumental activities of daily living and behavioural disturbance (67, 50 and 30 fewer days, respectively). Total societal costs, total patient costs and, to a lesser extent, patient healthcare-only costs were associated with time to institutionalisation. In the 5 years pre-institutionalisation, monthly total societal costs increased by more than £1000 (€1166 equivalent for 2010) from £1900 to £3160 and monthly total patient costs almost doubled from £770 to £1529.

Conclusions

Total societal costs and total patient costs rise steeply as community-dwelling patients with AD dementia approach institutionalisation.

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Title: Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer’s disease dementia
Authors: Mark Belger
Josep Maria Haro
Catherine Reed
Michael Happich
Josep Maria Argimon
Giuseppe Bruno
Richard Dodel
Roy W. Jones
Bruno Vellas
Anders Wimo
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: The European Journal of Health Economics / Issue 3/2019
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI: https://doi.org/10.1007/s10198-018-1001-3

At a glance: The STEP trials

Springer Medicine

Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer’s disease dementia

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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