Exploring the Relationship between Alzheimer's Disease Severity and Longitudinal Costs

Abstract Objective The joint impact of cognitive, functional, and behavioral statuses must be measured when exploring the impact of new drugs on Alzheimer's disease (AD) costs. There are very few recent studies of AD costs by all dimensions of disease severity. Our objective was to improve esti...

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Bibliographic Details
Published in:Value in health 2012-05, Vol.15 (3), p.412-419
Main Authors: Rapp, Thomas, PhD, Andrieu, Sandrine, MD, PhD, Molinier, Laurent, MD, PhD, Grand, Alain, MD, PhD, Cantet, Christelle, MSc, Mullins, C. Daniel, PhD, Vellas, Bruno, MD, PhD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Alzheimer Disease - diagnosis
Alzheimer Disease - economics
Alzheimer Disease - physiopathology
Alzheimer's disease
Clinics
Community living
community-dwelling
cost
Costs and Cost Analysis
endogeneity
Female
France
Functional impairment
Health Care Costs - trends
Health costs
Humans
Internal Medicine
Longitudinal Studies
Male
Residential Facilities
Severity
Severity of Illness Index
Surveys and Questionnaires
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Summary:Abstract Objective The joint impact of cognitive, functional, and behavioral statuses must be measured when exploring the impact of new drugs on Alzheimer's disease (AD) costs. There are very few recent studies of AD costs by all dimensions of disease severity. Our objective was to improve estimation of the relationship between AD severity and costs of AD care by using more comprehensive AD data severity and a large sample size. Methods Participants were community-dwelling AD patients recruited between 2003 and 2005 and followed annually during a 2-year period in 50 French memory clinics. We used the Resource Use in Dementia questionnaire to estimate costs from a societal perspective. We explored the presence of potential endogeneity bias by using instrumental variable regressions. Results Cognitive declines impacted informal costs more than medical and nonmedical costs, while functional declines impacted nonmedical costs more than medical and informal costs. Both cognitive and function declines increased the total costs of care. We found that the endogeneity of these variables led to a large underestimation of their impact of AD severity on costs. Conclusion Potential endogeneity should be controlled for to prevent biased estimations of the impact of AD severity measures on costs.
ISSN:1098-3015
1524-4733
DOI:10.1016/j.jval.2012.02.003