The effects of patient function and dependence on costs of care in Alzheimer's disease

Carolyn W. Zhu, Christopher Leibman, Trent McLaughlin, Nikolaos Scarmeas, Marilyn Albert, Jason Brandt, Deborah Blacker, Mary Sano, Yaakov Stern

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: To estimate incremental effects of patients' dependence and function on costs of care during the early stages of Alzheimer's disease (AD) and to compare strengths of their relationships with different cost components. DESIGN: Multicenter, cross-sectional, observational study. SETTING: Three university hospitals in the United States. PARTICIPANTS: One hundred seventy-nine community-living patients with probable AD, with modified Mini-Mental State Examination scores of 30 or higher. MEASUREMENTS: Patients' dependence was measured using the Dependence Scale (DS). Functional capacity was measured using the Blessed Dementia Rating Scale (BDRS). Total cost was measured by summing direct medical costs and informal costs. Direct medical costs included costs of hospitalization, outpatient treatment and procedures, assistive devices, and medications. Informal costs were estimated from time spent helping with basic and instrumental activities of daily living for up to three caregivers per patient using national average hourly earnings as wage rate. RESULTS: DS and BDRS were associated with higher total cost; a 1-point increase in DS was associated with a $1,832 increase in total cost, and a 1-point increase in BDRS was associated with a $3,333 increase. Examining component costs separately identified potential differences between DS and BDRS. A 1-point increase in BDRS was associated with a $1,406 increase in direct medical cost. A 1-point increase in DS was associated with a $1,690 increase in informal cost. CONCLUSION: Patients' dependence and function related differently to direct medical and informal cost, suggesting that measures of function and dependence provided unique information for explaining variations in cost of care for patients with AD, highlighting the value in measuring both constructs.

Original languageEnglish (US)
Pages (from-to)1497-1503
Number of pages7
JournalJournal of the American Geriatrics Society
Volume56
Issue number8
DOIs
StatePublished - Aug 2008

Keywords

  • Alzheimer's disease
  • Cost
  • Dependence
  • Function

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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