Costs and Resource Use Associated with Community-Dwelling Patients with Alzheimer’s Disease in Japan: Baseline Results from the Prospective Observational GERAS-J Study

Nakanishi, Miharu; Igarashi, Ataru; Ueda, Kaname; Brnabic, Alan; Treuer, Tamás; Sato, Masayo; Kahle-Wrobleski, Kristin; Meguro, Kenichi; Yamada, Masahito; Mimura, Masaru; Arai, Heii

doi:10.3233/jad-190811

Cited by 16 publications

(40 citation statements)

References 32 publications

(53 reference statements)

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“…GERAS-J was a prospective, multicenter, observational cohort study of the routine care of patients with AD in Japan with an 18-month follow-up period [12]. Community-dwelling patients and their primary caregivers providing unpaid informal care were enrolled from November 2016 to December 2017.…”

Section: Methodsmentioning

confidence: 99%

“…Community-dwelling patients and their primary caregivers providing unpaid informal care were enrolled from November 2016 to December 2017. Detailed study design and methods have previously been published [12]. The 30 sites in the GERAS-J study included a variety of memory clinic settings (5 clinics, 12 hospitals, and 13 university hospitals) in different regions of Japan, where patients are routinely seen for diagnosis and follow-up for dementia due to AD.…”

Section: Methodsmentioning

confidence: 99%

“…Eligible patients were males and females aged ≥55 years old, who had received a diagnosis of probable AD according to the National Institute on Aging and Alzheimer's Association [13] and with a Mini-Mental State Examination (MMSE) [14] score of 26 or less. The patients were being treated at outpatient memory clinics that routinely treat patients with AD [12]. At study entry, patients were classified into groups of mild, moderate, and moderately severe/severe [MS/S] according to AD severity at baseline using MMSE [14] Patients (or their representatives) and primary caregivers provided written, informed consent for the collection and release of personal health information.…”

Section: Patientsmentioning

confidence: 99%

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Costs and resource use of community-dwelling patients with Alzheimer’s disease in Japan: 18-month results from the GERAS-J study

Nakanishi

Igarashi

Ueda

et al. 2021

Current Medical Research and Opinion

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Objective: To determine the longitudinal societal costs and burden of community-dwelling patients with Alzheimer's disease (AD) and their caregivers in Japan.Methods: GERAS-J was an 18-month, prospective, longitudinal, observational study. Using the Mini-Mental State Examination (MMSE), patients routinely visiting memory clinics were stratified into groups based on AD severity at baseline (mild, moderate, and moderately severe/severe [MS/S]). Healthcare resource utilization and caregiver burden were assessed using the Resource Utilization in Dementia and Zarit "Caregiver" Burden Interview questionnaires, respectively. Total monthly societal costs were estimated using Japan-specific unit costs of services and products (patient direct healthcare use, patient social care use, and informal caregiving time).Results: Overall, 553 patients (156 mild; 209 moderate; 188 MS/S) were enrolled. MMSE scores declined (1.73, 1.38, and 0.95 points for the mild, moderate, and MS/S AD groups, respectively) and caregiver burden and resource utilization increased over 18 months in each of the AD severity groups. Cumulative total societal costs per patient over 18 months were 3.1, 3.8, and 5.3 million Japanese yen (29,006, 35,662, and 49,725 USD) for mild, moderate, and MS/S AD, respectively. Both patient social care costs and caregiver informal care costs increased with baseline disease severity, with >50% of total costs due to caregiver informal care in each disease severity subgroup. A c c e p t e d M a n u s c r i p tConclusions: Total treatment costs increased with AD severity over 18 months due to increases in both patient social care costs and caregiver informal care costs. Our data suggest current social care services in Japan are insufficient to alleviate the negative impact of AD on caregiver burden.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

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Costs and resource use of community-dwelling patients with Alzheimer’s disease in Japan: 18-month results from the GERAS-J study

Nakanishi

Igarashi

Ueda

et al. 2021

Current Medical Research and Opinion

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“…The burden on caregivers increases with the severity of AD [15]. When the severity of AD increases to an extent that it badly affects daily functioning, patients' activities of daily living (ADL) are impaired and they need help from others in managing their daily lives [16,17].…”

Section: Introductionmentioning

confidence: 99%

Impact of the Severity of Alzheimer’s Disease on the Quality of Life, Activities of Daily Living, and Caregiving Costs for Institutionalized Patients on Anti-Alzheimer Medications in Japan

Ashizawa

Igarashi

Sakata

et al. 2021

JAD

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Background: Alzheimer’s disease (AD) increases societal costs and decreases the activities of daily living (ADL) and quality of life (QoL) of the affected individuals. Objective: We assess the impact of AD severity on ADL, QoL, and caregiving costs in Japanese facilities for the elderly. Methods: Patients with AD in facilities for the elderly were included (47 facilities, N = 3,461). The QoL, ADL, and disease severity of patients were assessed using Barthel Index (BI), EuroQoL-5D-5L (EQ-5D-5L), and Mini-Mental State Examination (MMSE), respectively. Annual caregiving costs were estimated using patients’ claims data. The patients were subcategorized into the following three groups according to the MMSE score: mild (21≤MMSE≤30), moderate (11≤MMSE≤20), and severe (0≤MMSE≤10). Changes among the three groups were evaluated using the Jonckheere-Terpstra test. Results: Four hundred and one participants were on anti-AD medicines, of whom 287 (age: 86.1±6.4 years, 76.7% women) in the mild (n = 53, 84.0±6.9 years, 71.7%), moderate (n = 118, 86.6±5.9 years, 76.3%), and severe (n = 116, 86.6±6.5 years, 79.3%) groups completed the study questionnaires. The mean BI and EQ-5D-5L scores for each group were 83.6, 65.1, and 32.8 and 0.801, 0.662, and 0.436, respectively. The mean annual caregiving costs were 2.111, 2.470, and 2.809 million JPY, respectively. As AD worsened, the BI and EQ-5D-5L scores decreased and annual caregiving costs increased significantly. Conclusion: AD severity has an impact on QoL, ADL, and caregiving costs.

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“…As the number of people with dementia increases globally [1], dementia has become a public health priority [2,3]. Dementia has significant social and economic implications in terms of direct medical and social care costs, and the costs of informal care [4][5][6]. Neuropsychiatric symptoms contribute to the overall costs of dementia care, both in the community [7,8] and in care homes [9].…”

Section: Introductionmentioning

confidence: 99%

Time Investment for Program Implementation to Manage Neuropsychiatric Symptoms: An Observational Longitudinal Study in In-Home and Residential Care Settings

Nakanishi

Niimura

Ziylan

et al. 2020

ADR

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Background: There are no studies on how the same psychosocial dementia care program is adapted to both in-home and residential care settings. Objective: To evaluate the time investment required by professionals to implement a psychosocial dementia care program to manage neuropsychiatric symptoms. Methods: A prospective observational study design was used. The program consisted of 1) a one-day training course, 2) three interdisciplinary discussion meetings in five months, and 3) a web-based tool for the continued assessment of neuropsychiatric symptoms. Care professionals implemented the intervention in in-home (19 in-home care management agencies and 14 multiple in-home service providers) and residential care settings (19 group homes and eight nursing homes) in Japan from October 2019 to February 2020. The level of neuropsychiatric symptoms for the participants was evaluated using the Neuropsychiatric Inventory (NPI: 0–144). The time investment was reported by participating professionals. A total of 125 persons with dementia were included at baseline. Results: Neuropsychiatric symptoms were significantly decreased at the final follow-up in all types of providers (Cohen’s drm = 0.44–0.61). The mean (SD) time required for the five-month implementation was 417.9 (219.8) minutes. There was a mean (SD) decrease of 8.6 (14.0) points in the total NPI score among the 103 persons with completed interventions. The time investment was significantly lower in in-home care management agencies than in group homes, and lower in follow-ups than at baseline assessment. Conclusion: The program implementation may incur a substantial time investment regardless of setting. An additional benefit scheme to reward the time investment would be helpful to encourage implementation until the follow-ups.

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Costs and Resource Use Associated with Community-Dwelling Patients with Alzheimer’s Disease in Japan: Baseline Results from the Prospective Observational GERAS-J Study

Cited by 16 publications

References 32 publications

Costs and resource use of community-dwelling patients with Alzheimer’s disease in Japan: 18-month results from the GERAS-J study

Costs and resource use of community-dwelling patients with Alzheimer’s disease in Japan: 18-month results from the GERAS-J study

Impact of the Severity of Alzheimer’s Disease on the Quality of Life, Activities of Daily Living, and Caregiving Costs for Institutionalized Patients on Anti-Alzheimer Medications in Japan

Time Investment for Program Implementation to Manage Neuropsychiatric Symptoms: An Observational Longitudinal Study in In-Home and Residential Care Settings

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