The economic cost of Alzheimer's disease: Family or public-health burden?

Castro, Diego M.; Dillon, Carol; Machnicki, Gerardo; Allegri, Ricardo F.

doi:10.1590/S1980-57642010DN40400003

Abstract

Alzheimer's disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members) are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services) increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options.

Key words:
Alzheimer's disease; economic costs; health economics

Resumo

O paciente com doença de Alzheimer (DA) sofre comprometimento progressivo cognitivo, comportamental e funcional, que resulta numa grande sobrecarga aos pacientes, familiares e à saúde pública. A DA inclui custos diretos e indiretos. Os custos indiretos (como perda ou redução dos ganhos pelo paciente ou membros da família) são os mais importantes custos dos pacientes leves e na comunidade. Os custos diretos (tais como tratamento médico ou serviços sociais) aumentam com a progressão da doença, quando o paciente é institucionalizado ou quando um cuidador formal é requerido. A terapia com drogas representam um aumento nos custos diretos, mas podem reduzir alguns outros custos diretos ou indiretos envolvidos. Vários estudos projetam uma economia global da sociedade quando é usada terapia com drogas e todos os custos relevantes são considerados; e os resultados dependerão de um paciente específico e características do meio envolvido no cuidado. A demência pode ser um assunto de análise quando as políticas de saúde são desenhadas. Os países da América do Sul deveriam fortalecer suas políticas e capacidades de planejamento, pela geração de maiores evidências locais sobre a sobrecarga da DA e como poderia ser norteada pelas opções de tratamento.

Palavras-chave:
doença de Alzheimer; custos econômicos; economia de saúde

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Full text available only in PDF format.

References

Arizaga RL. Epidemiology of dementia. In: Mangone CA, Allegri RF, Arizaga RL, Ollari JA, editors. Dementia: a multidisciplinary approach. 2nd ed. Buenos Aires: Ed. Polemos; 2005:7-17.
Fratiglioni L, Rocca WA. Epidemiology of dementia. In: Boller F, Cappa SF, editors. Handbook of neuropsychology. 2nd ed. Amsterdam: Elsevier; 2001:193-215
Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision (July, 2009), available on line http://esa.un.org/unpp
» http://esa.un.org/unpp
Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366(9503): 2112-2117.
Allegri RF, Butman J, Arizaga RL, et al. Economic impact of dementia in developing countries: an evaluation of costs of Alzheimer-type dementia in Argentina. Int Psychogeriatr 2007;19:705-718.
Meek PD, McKeithan K, Schumock GT. Economic considerations in Alzheimer's disease. Pharmacotherapy 1998;18(2 Pt 2):68-73.
Wimo A, Winblad B, Jönsson L. An estimate of the total worldwide societal costs of dementia in 2005. Alzheimers Dement 2007;3:81-91.
Wang G, Cheng Q, Zhang S, et al. Economic impact of dementia in developing countries: an evaluation of Alzheimer-type dementia in Shanghai, China. J Alzheimer Dis 2008;15: 109-15.
Lopez-Bastida J, Serrano-Aguilar P, Perestelo-Perez L, Oliva-Moreno J. Social-economic costs and quality of life of Alzheimer disease in the Canary Islands, Spain. Neurology 2006;67:2186-2191.
Zencir M, Kuzu N, Beser NG, Ergin A, Catak B, Sahiner T. Cost of Alzheimer's disease in a developing country setting, Int J Geriatr Psychiatry 2005;20:616-622.
Beeri MS, Werner P, Adar Z, Davidson M, Noy S. Economic cost of Alzheimer disease in Israel. Alzheimer Dis Assoc Disord 2002;16:73-80.
Cavallo MC, Fattore G. The economic and social burden of Alzheimer disease on families in the Lombardy region of Italy. Alzheimer Dis Assoc Disord 1997;11:184-190.
Ernst RL, Hay JW. The US economic and social costs of Alzheimer's disease revisited. Am J Public Health 1994;84: 1261-1264.
Boada M, Peña-Casanova J, Bermejo F, et al. Costs of health care resources of ambulatory-care patients diagnosed with Alzheimer's disease in Spain. Med Clin (Barc). 1999;113:690-695.
Hux MJ, O'Brien BJ, Iskedjian M, Goeree R, Gagnon M, Gauthier S. Relation between Alzheimer's disease and costs of caring. CMAJ 1998;159:457-465.
Rice DP, Fox PJ, Max W, et al. The economic burden of Alzheimer's disease care. Health Aff (Millwood) 1993;12:164-176.
Ernst RL, Hay JW, Fenn C, Tinklenberg J, Yesavage JA. Cognitive function and the costs of Alzheimer disease. An exploratory study. Arch Neurol 1997;54:687-693.
Hauber AB, Gnanasakthy A, Snyder EH, Bala MV, Richter A, Mauskopf JA. Potential savings in the cost of caring for Alzheimer's disease. Treatment with rivastigmine. Pharmacoeconomics 2000;17:351-160.
Lamb HM, Goa KL. Rivastigmine. A pharmacoeconomic review of its use in Alzheimer's disease. Pharmacoeconomics 2001;19:303-318.
Wimo A. Cost effectiveness of cholinesterase inhibitors in the treatment of Alzheimer's disease: a review with methodological considerations. Drugs Aging 2004;21:279-295.
Herrmann N, Lanctôt KL, Sambrook R, et al. The contribution of neuropsychiatric symptoms to the cost of dementia care. Int J Geriatr Psychiatry . 2006;21:972-976.
Zhu CW, Leibman C, McLaughlin T, et al. The effects of patient function and dependence on costs of care in Alzheimer's disease. J Am Geriatr Soc 2008;56:1497-1503.
Fillit HM. The pharmacoeconomics of Alzheimer's disease. Am J Manag Care 2000;6(22 Suppl):S1139-1144; discussion S1145-1148.
Brookmeyer R, Corrada MM, Curriero FC, Kawas C. Survival following a diagnosis of Alzheimer disease. Arch Neurol 2002;59:1764-1767.
Wimo A, Winblad B, Stoffler A, Wirth Y, Möbius HJ. Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer's disease. Pharmacoeconomics 2003;21:327-40.
Zhu CW, Sano M. Economic considerations in the management of Alzheimer's disease. Clin Interv Aging 2006;1:143-154.
Doody RS, Stevens JC, Beck C, et al. Practice parameter: management of dementia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology . Neurology 2001;56:1154-1166.
Waldemar G, Dubois B, Emre M, et al. EFNS. Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol. 2007;14:e1-26.
Feldman H, Gauthier S, Hecker J, et al. Donepezil MSAD Study Investigators Group. Economic evaluation of donepezil in moderate to severe Alzheimer disease. Neurology 2004; 63:644-650.
López-Bastida J, Hart W, García-Pérez L, Linertová R. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's Disease. J Alzheimers Dis 2009;16:399-407.
Sano M, Wilcock G, van Baelen B, Kavanagh S. The effects of galantamine treatment on caregiver time in Alzheimer's disease. Int J Geriatr Psychiatry 2003;18:942-50.
Migliaccio-Walle K, Getsios D, Caro JJ, Ishak KJ, O'Brien JA, Papadopoulos G. AHEAD Study Group. Economic evaluation of galantamine in the treatment of mild to moderate Alzheimer's disease in the United States. Clin Ther 2003;25: 1806-1825.
Suh GH, Jung HY, Lee CU, Choi S. Korean Galantamine Study Group. Economic and clinical benefits of galantamine in the treatment of mild to moderate Alzheimer's disease in a Korean population: a 52-week prospective study. J Korean Med Sci 2008;23:10-17.
Grossberg GT. Impact of rivastigmine on caregiver burden associated with Alzheimer's disease in both informal care and nursing home settings. Drugs Aging 2008;25:573-584.
Marin D, Amaya K, Casciano R, et al. Impact of rivastigmine on costs and on time spent in caregiving for families of patients with Alzheimer's disease. Int Psychogeriatr 2003; 15:385-398.
Francois C, Sintonen H, Sulkava R, Rive B. Cost effectiveness of memantine in moderately severe to severe Alzheimer's disease: a Markov Model in Finland. Clin Drug Investig 2004: 24:373-384.
Jones RW, McCrone P, Guilhaume C. Cost effectiveness of memantine in Alzheimer's disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging 2004;21:607-620.
Mucha L, Shaohung S, Cuffel B, McRae T, Mark TL, Del Valle M. Comparison of cholinesterase inhibitor utilization patterns and associated health care costs in Alzheimer's disease. J Manag Care Pharm. 2008;14:451-461.
Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, Clegg A. The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technol Assess 2006;10(1):iii-iv, ix-xi, 1-160.
Moore MJ, Zhu CW, Clipp EC. Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study. J Gerontol B Psychol Sci Soc Sci 2001;56:S219-228.
Knapp M, Comas-Herrera A, Somani A, Banerjee S. Dementia: international comparisons. Summary report for the National Audit Office. Web site of the Personal Social Services Research Unit, May 2007 Available on line http://www.pssru.ac.uk/pdf/dp2418.pdf
» http://www.pssru.ac.uk/pdf/dp2418.pdf
Zhu CW, Torgan R, Scarmeas N, et al. Home health and informal care utilization and costs over time in Alzheimer's disease. Home Health Care Serv Q 2008;27:1-20.
Covinsky KE, Newcomer R, Fox P, et al. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med 2003;18:1006-1014.
Schoenmakers B, De Lepeleire J, Ylieff M, Fontaine O, Buntinx F. The burden of family care giving in Dementia. Arch Public Health 2004; 62:157-172. Available on line http://www.iph.fgov.be/aph/pdf/aphfull62_157_172.pdf
» http://www.iph.fgov.be/aph/pdf/aphfull62_157_172.pdf
Mahoney R, Regan C, Katona C, Livingston G. Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. Am J Geriatr Psychiatry 2005;13: 795-801
Cooper C, Balamurali TB, Livingston G. A systematic review of the prevalence and covariates of anxiety in caregivers of people with dementia. Int Psychogeriatr 2007;19:175-195.
Veras RP, et al. Family care for demented elderly individuals: cost analysis. Rev Psiq Clín 2007;34: 5-12.
Rojas G, Bartoloni L, Dillon C, Serrano CM, Iturry M, Allegri RF. Clinical and economic characteristics associated with direct costs of Alzheimer's, frontotemporal and vascular dementia in Argentina. Int Psychogeriatr 2010;3:1-8.

Publication Dates

Publication in this collection
Oct-Dec 2010

History

Received
25 Aug 2010
Accepted
22 Oct 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

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[2] Fratiglioni L, Rocca WA. Epidemiology of dementia. In: Boller F, Cappa SF, editors. Handbook of neuropsychology. 2nd ed. Amsterdam: Elsevier; 2001:193-215

[3] Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision (July, 2009), available on line http://esa.un.org/unpp
» http://esa.un.org/unpp

[4] Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366(9503): 2112-2117.

[5] Allegri RF, Butman J, Arizaga RL, et al. Economic impact of dementia in developing countries: an evaluation of costs of Alzheimer-type dementia in Argentina. Int Psychogeriatr 2007;19:705-718.

[6] Meek PD, McKeithan K, Schumock GT. Economic considerations in Alzheimer's disease. Pharmacotherapy 1998;18(2 Pt 2):68-73.

[7] Wimo A, Winblad B, Jönsson L. An estimate of the total worldwide societal costs of dementia in 2005. Alzheimers Dement 2007;3:81-91.

[8] Wang G, Cheng Q, Zhang S, et al. Economic impact of dementia in developing countries: an evaluation of Alzheimer-type dementia in Shanghai, China. J Alzheimer Dis 2008;15: 109-15.

[9] Lopez-Bastida J, Serrano-Aguilar P, Perestelo-Perez L, Oliva-Moreno J. Social-economic costs and quality of life of Alzheimer disease in the Canary Islands, Spain. Neurology 2006;67:2186-2191.

[10] Zencir M, Kuzu N, Beser NG, Ergin A, Catak B, Sahiner T. Cost of Alzheimer's disease in a developing country setting, Int J Geriatr Psychiatry 2005;20:616-622.

[11] Beeri MS, Werner P, Adar Z, Davidson M, Noy S. Economic cost of Alzheimer disease in Israel. Alzheimer Dis Assoc Disord 2002;16:73-80.

[12] Cavallo MC, Fattore G. The economic and social burden of Alzheimer disease on families in the Lombardy region of Italy. Alzheimer Dis Assoc Disord 1997;11:184-190.

[13] Ernst RL, Hay JW. The US economic and social costs of Alzheimer's disease revisited. Am J Public Health 1994;84: 1261-1264.

[14] Boada M, Peña-Casanova J, Bermejo F, et al. Costs of health care resources of ambulatory-care patients diagnosed with Alzheimer's disease in Spain. Med Clin (Barc). 1999;113:690-695.

[15] Hux MJ, O'Brien BJ, Iskedjian M, Goeree R, Gagnon M, Gauthier S. Relation between Alzheimer's disease and costs of caring. CMAJ 1998;159:457-465.

[16] Rice DP, Fox PJ, Max W, et al. The economic burden of Alzheimer's disease care. Health Aff (Millwood) 1993;12:164-176.

[17] Ernst RL, Hay JW, Fenn C, Tinklenberg J, Yesavage JA. Cognitive function and the costs of Alzheimer disease. An exploratory study. Arch Neurol 1997;54:687-693.

[18] Hauber AB, Gnanasakthy A, Snyder EH, Bala MV, Richter A, Mauskopf JA. Potential savings in the cost of caring for Alzheimer's disease. Treatment with rivastigmine. Pharmacoeconomics 2000;17:351-160.

[19] Lamb HM, Goa KL. Rivastigmine. A pharmacoeconomic review of its use in Alzheimer's disease. Pharmacoeconomics 2001;19:303-318.

[20] Wimo A. Cost effectiveness of cholinesterase inhibitors in the treatment of Alzheimer's disease: a review with methodological considerations. Drugs Aging 2004;21:279-295.

[21] Herrmann N, Lanctôt KL, Sambrook R, et al. The contribution of neuropsychiatric symptoms to the cost of dementia care. Int J Geriatr Psychiatry . 2006;21:972-976.

[22] Zhu CW, Leibman C, McLaughlin T, et al. The effects of patient function and dependence on costs of care in Alzheimer's disease. J Am Geriatr Soc 2008;56:1497-1503.

[23] Fillit HM. The pharmacoeconomics of Alzheimer's disease. Am J Manag Care 2000;6(22 Suppl):S1139-1144; discussion S1145-1148.

[24] Brookmeyer R, Corrada MM, Curriero FC, Kawas C. Survival following a diagnosis of Alzheimer disease. Arch Neurol 2002;59:1764-1767.

[25] Wimo A, Winblad B, Stoffler A, Wirth Y, Möbius HJ. Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer's disease. Pharmacoeconomics 2003;21:327-40.

[26] Zhu CW, Sano M. Economic considerations in the management of Alzheimer's disease. Clin Interv Aging 2006;1:143-154.

[27] Doody RS, Stevens JC, Beck C, et al. Practice parameter: management of dementia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology . Neurology 2001;56:1154-1166.

[28] Waldemar G, Dubois B, Emre M, et al. EFNS. Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol. 2007;14:e1-26.

[29] Feldman H, Gauthier S, Hecker J, et al. Donepezil MSAD Study Investigators Group. Economic evaluation of donepezil in moderate to severe Alzheimer disease. Neurology 2004; 63:644-650.

[30] López-Bastida J, Hart W, García-Pérez L, Linertová R. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's Disease. J Alzheimers Dis 2009;16:399-407.

[31] Sano M, Wilcock G, van Baelen B, Kavanagh S. The effects of galantamine treatment on caregiver time in Alzheimer's disease. Int J Geriatr Psychiatry 2003;18:942-50.

[32] Migliaccio-Walle K, Getsios D, Caro JJ, Ishak KJ, O'Brien JA, Papadopoulos G. AHEAD Study Group. Economic evaluation of galantamine in the treatment of mild to moderate Alzheimer's disease in the United States. Clin Ther 2003;25: 1806-1825.

[33] Suh GH, Jung HY, Lee CU, Choi S. Korean Galantamine Study Group. Economic and clinical benefits of galantamine in the treatment of mild to moderate Alzheimer's disease in a Korean population: a 52-week prospective study. J Korean Med Sci 2008;23:10-17.

[34] Grossberg GT. Impact of rivastigmine on caregiver burden associated with Alzheimer's disease in both informal care and nursing home settings. Drugs Aging 2008;25:573-584.

[35] Marin D, Amaya K, Casciano R, et al. Impact of rivastigmine on costs and on time spent in caregiving for families of patients with Alzheimer's disease. Int Psychogeriatr 2003; 15:385-398.

[36] Francois C, Sintonen H, Sulkava R, Rive B. Cost effectiveness of memantine in moderately severe to severe Alzheimer's disease: a Markov Model in Finland. Clin Drug Investig 2004: 24:373-384.

[37] Jones RW, McCrone P, Guilhaume C. Cost effectiveness of memantine in Alzheimer's disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging 2004;21:607-620.

[38] Mucha L, Shaohung S, Cuffel B, McRae T, Mark TL, Del Valle M. Comparison of cholinesterase inhibitor utilization patterns and associated health care costs in Alzheimer's disease. J Manag Care Pharm. 2008;14:451-461.

[39] Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, Clegg A. The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technol Assess 2006;10(1):iii-iv, ix-xi, 1-160.

[40] Moore MJ, Zhu CW, Clipp EC. Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study. J Gerontol B Psychol Sci Soc Sci 2001;56:S219-228.

[41] Knapp M, Comas-Herrera A, Somani A, Banerjee S. Dementia: international comparisons. Summary report for the National Audit Office. Web site of the Personal Social Services Research Unit, May 2007 Available on line http://www.pssru.ac.uk/pdf/dp2418.pdf
» http://www.pssru.ac.uk/pdf/dp2418.pdf

[42] Zhu CW, Torgan R, Scarmeas N, et al. Home health and informal care utilization and costs over time in Alzheimer's disease. Home Health Care Serv Q 2008;27:1-20.

[43] Covinsky KE, Newcomer R, Fox P, et al. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med 2003;18:1006-1014.

[44] Schoenmakers B, De Lepeleire J, Ylieff M, Fontaine O, Buntinx F. The burden of family care giving in Dementia. Arch Public Health 2004; 62:157-172. Available on line http://www.iph.fgov.be/aph/pdf/aphfull62_157_172.pdf
» http://www.iph.fgov.be/aph/pdf/aphfull62_157_172.pdf

[45] Mahoney R, Regan C, Katona C, Livingston G. Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. Am J Geriatr Psychiatry 2005;13: 795-801

[46] Cooper C, Balamurali TB, Livingston G. A systematic review of the prevalence and covariates of anxiety in caregivers of people with dementia. Int Psychogeriatr 2007;19:175-195.

[47] Veras RP, et al. Family care for demented elderly individuals: cost analysis. Rev Psiq Clín 2007;34: 5-12.

[48] Rojas G, Bartoloni L, Dillon C, Serrano CM, Iturry M, Allegri RF. Clinical and economic characteristics associated with direct costs of Alzheimer's, frontotemporal and vascular dementia in Argentina. Int Psychogeriatr 2010;3:1-8.

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