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Original Research

Relationship between patient dependence and direct medical-, social-, indirect-, and informal-care costs in Spain

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Pages 387-395 | Published online: 02 Jul 2015
 

Abstract

Objective

The objectives of this analysis were to examine how patients’ dependence on others relates to costs of care and explore the incremental effects of patient dependence measured by the Dependence Scale on costs for patients with Alzheimer’s disease (AD) in Spain.

Methods

The Co-Dependence in Alzheimer’s Disease study is an 18 multicenter, cross-sectional, observational study among patients with AD according to the clinical dementia rating score and their caregivers in Spain. This study also gathered data on resource utilization for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. The data of 343 patients and their caregivers were collected through the completion of a clinical report form during one visit/assessment at an outpatient center or hospital, where all instruments were administered. The data collected (in addition to clinical measures) also included sociodemographic data concerning the patients and their caregivers. Cost analysis was based on resource use for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. Resource unit costs were applied to value direct medical-, social-, and indirect-care costs. A replacement cost method was used to value informal care. Patient dependence on others was measured using the Dependence Scale, and the Cumulative Index Rating Scale was administered to the patient to assess multi-morbidity. Multivariate regression analysis was used to model the effects of dependence and other sociodemographic and clinical variables on cost of care.

Results

The mean (standard deviation) costs per patient over 6 months for direct medical-, social-, indirect-, and informal-care costs were estimated at €1,028.10 (€1,655.00), €843.80 (€2,684.80), €464.20 (€1,639.00), and €33,232.20 (€30,898.90), respectively. Dependence was independently and significantly associated with direct medical-, social-, informal-, and total-care costs.

Conclusion

The costs of care for patients with AD in Spain are substantial, with informal care accounting for the greatest part. Interventions that reduce patient dependence on caregivers may be associated with important reduction in direct medical-, social-, informal-, and total-care costs.

Acknowledgments

The authors would like to thank all the health care professionals of the study centers and study participants in the project.

Author contributions

Josep Darbà’s and Lisette Kaskens’s contributions include the designing of the study, conducting the statistical analysis and interpretation of the data, and writing and revising the manuscript. Josep Darbà is guarantor of the manuscript.

Disclosure

This study was sponsored by Pfizer Inc and Janssen Alzheimer Immunotherapy Research and Development, LLC. Josep Darbà is employed by the University of Barcelona and was involved as an external advisor hired by Pfizer Inc and Jans-sen Alzheimer Immunotherapy Research and Development. Lisette Kaskens is an employee of BCN Health, who was paid consultants to Janssen Alzheimer Immunotherapy Research and Development, LLC and Pfizer Inc.