Determinants of Medical Direct Costs of Care among Patients of a Memory Center

Abstract

Background: Alzheimer’s disease and related diseases (ADRD) are a major cause of health-related cost increase. Objectives: This study aimed to estimate the real medical direct costs of care of patients followed at a memory center, and to investigate potential associations between patients’ characteristics and costs. Design: Cross-sectional analyses conducted on matched data between clinical data of a cohort of patients and the claims database of the French Primary Health Insurance Fund. Setting: Memory center in France Participants: Patients attending a memory center with subjective cognitive complaint Measurements: Medical or nonmedical direct costs (transportation) reimbursed by the French health insurance during the one year after the first memory visit, and socio-demographic, clinical, cognitive, functional, and behavioral characteristics were analyzed. Results: Among 2,746 patients (mean ± SD age 79.9 ± 8 years, 42.4% of patients with dementia), the total direct cost was on average € 9,885 per patient during the year after the first memory visit: € 7,897 for patients with subjective cognitive complaint, € 9,600 for patients with MCI, and € 11,505 for patients with dementia. A higher functional and cognitive impairment, greater behavioral disorders, and a higher caregiver burden were independently associated with a higher total direct cost. A one-point decrease in the Instrumental Activities of Daily Living score was associated with a € 1,211 cost increase. The cost was higher in patients with Parkinson’s disease, and Lewy body disease compared to patients with AD. Diabetes mellitus, anxiety disorders and number of drugs were also significantly associated with greater costs. Conclusions: Higher real medical direct costs were independently associated with cognitive, functional, and behavioral impairment, diabetes mellitus, anxiety disorders, number of drugs, etiologies as well as caregiver burden in patients attending a memory center. The identification of factors associated to higher direct costs of care offers additional direct targets to evaluate how interventions conducted in patients with NCD impact direct costs of care.

Economic and caregiver impact of Alzheimer’s disease across the disease spectrum: a cohort study

“…In the present study, the patients’ clinical data were matched 1 year before and 2 years after the first memory consultation with claims data from the local branch of the PHIF (Caisse Primaire d’Assurance Maladie du Rhône [CPAM]) database for patients from the MEMORA cohort who underwent a consultation at a memory clinic of the Lyon University Hospital in France between 2014 and 2019. This claims database included all the direct medical costs taken in charge by the national healthcare system, as well as medical transportation [ 12 ]. All patients had cognitive complaints, which were expressed by the patient or caregiver.…”

The high cost of care and limited evidence on cost-effective strategies for Lewy body dementia: systematic review of evidence

“…Two of the ten studies focused exclusively on the costs associated with LBD. 18,19 Six studies compared the costs of care between different subtypes of dementia, [20][21][22] including three studies that examined costs related to LBD and Alzheimer's disease. [23][24][25] Additionally, three studies assessed care costs for people with mild and/or moderate dementia.…”

“…The ten studies had varied levels of quality. Regarding the analytical framework employed, six studies 18,[20][21][22][23]27 met all six criteria. Regarding methodology and data, most studies did not meet the criteria, with the exception of one study 25 that met all nine criteria.…”

Neuroimaging and plasma marker evidence for white matter macrostructure loss in Parkinson’s disease

“…As well as the well-described motor symptoms of rest tremor, rigidity and bradykinesia, around half of all patients will develop dementia within 10 years’ of diagnosis 2 . Other poor outcomes include frailty and falls due to postural instability; and PD dementia has higher societal and economic burden than other dementias 3,4 . However the timing and rate of clinical deterioration varies greatly 2,5 as does the underlying brain pathology, with varying degrees and locations of alpha-synuclein, and the extent and severity of beta-amyloid and tau pathological accumulations 6 .…”