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

Abstract

Background Alzheimer’s disease (AD) substantially increases health-related costs. This study investigates direct medical costs and characterizes the caregiver burden across AD stages. Methods This study analyzed data from the French Primary Health Insurance Fund claims database and reflected this public payer perspective. Outpatients (N = 1998) visiting a memory clinic at Lyon University Hospital in France between 2014 and 2019 were included. Real healthcare costs (ie, ambulatory medicine, paramedical care, pharmaceutical treatment, public and private hospital stays, and medical transportation) were collected for patients 1 year prior to the date of the first memory visit and 2 years following the first visit (reference year: 2019). Patients were grouped based on a clinical diagnosis of cognitively normal with a subjective cognitive complaint (SCC), all-cause mild cognitive impairment (MCI), or AD dementia. The severity of AD dementia was defined by the Mini-Mental State Examination score. Caregiver burden was measured using the mini Zarit Burden Interview. A generalized linear model was used for statistical analyses. Other patient nonmedical and indirect costs and caregiver costs were not included. Results The study sample included patients with SCC (n = 640), MCI (n = 630), mild (n = 212), moderate (n = 256), or moderately severe/severe AD dementia (n = 260). One year after the first consultation, mean total costs were higher with progressive cognitive deficit, with little difference between dementia groups (SCC = €8028; MCI = €9758; mild AD dementia = €10,558; moderate AD dementia = €10,544; moderately severe/severe AD dementia = €10,345; P < .001). Public hospital stays comprised the majority of direct medical costs during the first semester following the visit (49.4% of the total costs), regardless of the severity of cognitive deficit. Caregiver burden increased with the severity of cognitive deficit (P < .0001). Conclusions Direct medical costs and caregiver burden rose from SCC to AD dementia; in patients with AD dementia, the direct medical costs increased over the 2 years after the first consultation. These results, in conjunction with data from other care components, will be critical to elucidate the potential economic value of a therapeutic intervention that slows AD progression.

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“…Also it is projected that AD costs increases due to the growth in its prevalence and treatment costs. The societal financial burden of AD is estimated to rise by about 4.9-fold in the USA (to $1.5 trillion), 2.7-fold in Europe (to €633 billion), and 9.5-fold worldwide (to $9.1 trillion), by 2050 (Dauphinot et al, 2022;Tahami Monfared et al, 2022). Consequently, finding new effective ways to prevent or treat AD can be very worthwhile when increasing health costs is taken into account.…”

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“…Over time, patients with AD often develop symptoms that are beyond the capabilities of caregivers to manage with the result that patients end up in a long-term care facility and incur an enormous economic burden [9,11]. Thus, any delay in symptom onset or progression may result in a substantial impact on caregiver and economic burden.…”

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“…Alzheimer's disease (AD) is a cognitive disease. AD is the principal pathology in the world displaying negative impacts on both the health and social ability of patients while inducing considerable economic costs (Dauphinot et al, 2022). AD is one of the greatest health challenges of this century for humanity (DeTure and Dickson, 2019;Klatt et al, 2019;Eftychios et al, 2021).…”