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

Figures & data

Table 1 Sociodemographic variables and clinical characteristics

Variable	Measure	Number of observations
Patient-related variables
Sex – n (%)		342
Male	113 (33.0%)
Female	229 (67.0%)
Age (years), mean (SD)	78.9 (7.4)	342
Place of residence – n (%)		341
Own/family home	336 (98.5%)
Institutionalized	5 (1.5%)
Civil status – n (%)		342
Married/partner	201 (58.8%)
Others	141 (41.2%)
Years since diagnosis, mean (SD)	2.3 (2.3)	275
Caregiver-related variables		311
Relation – n (%)
Spouse	141 (45.3%)
Others	170 (54.7%)
Age (years), mean (SD)	60.4 (14.1)	342
Sex – n (%)		342
Male	118 (34.5%)
Female	224 (65.5%)
Living with the patient – n (%)		342
Yes	240 (70.2%)
No	102 (29.8%)
Clinical characteristics
DS score, mean (SD)	8.0 (3.1)	338
DS score grouped – n (%)		338
0–6	108 (32.0%)
7–8	76 (22.5%)
9–10	79 (23.4%)
11–15	75 (22.2%)
CDR – n (%)		339
0.5	18 (5.3%)
1	116 (34.2%)
2	102 (30.1%)
3	103 (30.4%)
CIRS, mean (SD)	5.5 (4.0)	340

Abbreviations: CDR, Clinical Dementia Rating; CIRS, Cumulative Illness Rating Scale; DS, Dependence Scale; n, number of patients; SD, standard deviation.

Table 2 Unit cost estimates

Resource item	Activity	Unit cost (€)
Medical care
Hospital admission	Per admission	458.89a
Emergency visit	Per visit	222.40a
Diagnostic and monitoring tests
Blood test	Per test	18.00
Vitamin B12	Per test	5.65
Folic acid	Per test	5.65
Thyroid hormones T3, T4, and TSH	Per test	19.23
Computerized axial tomography (CAT)	Per test	120.57
Liver tests	Per test	1.17
Neuropsychological explorations	Per test	118.58
Renal function	Per test	0.61
Syphilitic serologic	Per test	15.39
Urine analysis	Per test	1.54
Electrocardiography (ECG)	Per test	11.00
Chest X-ray	Per test	14.25
Electroencephalography (EEG)	Per test	45.67
Nuclear magnetic resonance (NMR)	Per test	192.54
HIV antibodies	Per test	237.29a
ApoE4	Per test	72.28^Citation29
Lumbar puncture	Per test	267.15
Positron emission tomography (PET)	Per test	556.31a
Medical visits
Primary care visit	Per visit	34.00
Geriatrics	Per visit	68.81^Citation30
Neurology	Per visit	68.81^Citation30
Psychiatry	Per visit	68.81^Citation30
Physiotherapist	Per visit	16.27
Occupational therapist	Per visit	21.50
Social assistant	Per visit	33.52
Psychologist	Per visit	69.95
Health material
Wheelchair	Per unit	247.32a
Walkers	Per pair	60.76a
Articulated bed	Per unit	1,906.52a
Anti-bedsore mattresses	Per unit	141.42
Underpad	Per unit	0.79
Remote alarm	Per unit	55.76
Diapers	Per unit	0.69
Social care
Day care	Per visit	30.48^Citation31
Health care assistant (assistant living)	Per visit	15.71^Citation31
Food delivery	Per meal	3.62^Citation32
Home nurse	Per visit	29.27
Transportation services	Per km	0.86a
Living in an institutionalized setting	Per month	2,018.61^Citation31
Day care center	Per visit	177.00
Indirect/productivity loss of employed caregiver
Hourly wage national level	Per hour	11.98^Citation33
Informal care
Replacement cost: health care assistant	Per hour	15.71^Citation31

Notes:

a Average of different costs provided by hospitals. Data was provided from the following hospitals: Hospital Zamora, Zamora, Castilla and Léon, 2011: Hospital Santiago de Compostela, Santiago de Compostela, Galicia, 2011: Hospital Elda, Elda, Valencia, 2011: Hospital de Elche, Elche, Valencia, 2011: Hospital Padre Menni, Santander, Cantabria, 2011: Hospital Santa Caterina, Girona, Catalonia, 2012: Instituto Andaluz de Neurociencia, Málaga, 2011.

Abbreviation: TSH, thyroid-stimulating hormone.

Table 3 Resource use

Resource item	Resource use in mean (SD) or n (%)
Medical care
Days hospitalized (over 6 months)	0.4 (0.6)
Number of emergency services attended (over 6 months)	1.5 (1.5)
Diagnostic tests (over 6 months)
Blood test	0.7 (0.8)
Vitamin B12	0.4 (0.6)
Folic acid	0.4 (0.6)
Thyroid hormones T3, T4, and TSH	0.4 (0.5)
Computerized axial tomography (CAT)	0.5 (0.5)
Liver tests	0.5 (0.8)
Neuropsychological explorations	0.4 (0.5)
Renal function	0.6 (0.8)
Syphilitic serologic	0.3 (0.5)
Urinalysis	0.5 (0.9)
Electrocardiography (ECG)	0.3 (0.5)
Chest X-ray	0.3 (0.5)
Electroencephalography (EEG)	0.1 (0.3)
Nuclear magnetic resonance (NMR)	0.1 (0.3)
HIV antibodies	0.02 (0.14)
Monitoring tests (over 6 months)
Blood test	1.1 (1.1)
Vitamin B12	0.4 (0.5)
Folic acid	0.4 (0.5)
Thyroid hormones T3, T4, and TSH	0.4 (0.5)
Computerized axial tomography (CAT)	0.3 (0.5)
Liver tests	0.3 (0.5)
Neuropsychological explorations	0.7 (0.5)
Renal function	0.4 (0.6)
Syphilitic serologic	0.2 (0.4)
Urinalysis	0.6 (0.7)
Electrocardiography (ECG)	0.4 (0.7)
Chest X-ray	0.3 (0.8)
Electroencephalography (EEG)	0.1 (0.3)
Nuclear magnetic resonance (NMR)	0.3 (0.5)
Brain SPECT	0.1 (0.3)
HIV antibodies	0.04 (0.19)
ApoE4	0.04 (0.21)
Lumbar puncture	0.02 (0.15)
Positron emission tomography (PET)	0.01 (0.11)
Medical visits (over 6 months)
Primary care	4.4 (7.5)
Geriatrics	0.08 (0.31)
Neurology	1.0 (0.7)
Psychiatry	0.6 (1.4)
Physiotherapist	1.5 (7.2)
Occupational therapist	2.6 (15.6)
Social assistant	0.1 (0.4)
Psychologist	1.3 (5.9)
Other	2.4 (7.9)
Health material (over 6 months)
Wheelchair	23 (8.0%)
Walkers	16 (5.6%)
Articulated bed	31 (10.8%)
Anti-bedsore mattresses	17 (6.1%)
Underpad	46 (15.9%)
Dressing materials	13 (4.6%)
Remote alarm	31 (10.8%)
Diapers	87 (28.8%)
Diapers per day	6.0 (19.4)
Social care
Complementary services (over 6 months)
Day care	18.6 (42.7)
Assisted living	12.3 (37.7)
Food delivery	1.8 (14.8)
Home nurse	0.5 (2.9)
Transportation services	7.3 (27.0)
Number of nights/living in institutionalized setting (over 6 months)	36.6 (73.2)
Home modifications (over 6 months)	68 (98.6%)
Attend to day center (over 6 months)	88 (26.3%)
Distance to day center in km (over 6 months)	6.8 (28.6)
Indirect/productivity loss of employed caregiver
Number of hours reduced (hours/week)	7.0 (7.8)
Complete workdays (8 hours/day) lost/last month	0.5 (1.1)
Partial workdays (4 hours/day) lost/last month	1.9 (5.3)
Informal care
Primary caregiver for basic ADLs (hours/month)	101.4 (170.0)
Secondary caregiver for basic ADLs (hours/month)	40.7 (94.8)
Primary caregiver for instrumental ADLs (hours/month)	106.8 (153.4)
Secondary caregiver for instrumental ADLs (hours/month)	45.3 (99.7)
Primary caregiver for patient monitoring (hours/month)	128.9 (198.9)
Secondary caregiver for patient monitoring (hours/month)	59.4 (123.9)

Abbreviations: ADLs, activities of daily living; n, number of patients; SD, standard deviation; TSH, thyroid-stimulating hormone; SPECT, single photon emission computed tomography.

Table 4 Summary of costs over previous 6 months

Cost variables	Number of observations	Cost (€ 2013)
		Mean (SD)	Median (IQR)
Direct medical care costs	343	1,028.12 (1,655.02)	530.80 (866.55)
Social care costs	343	843.85 (2,684.83)	0.02 (62.81)
Indirect care costs	343	464.21 (1,639.01)	0.01 (0.02)
Informal care costs	308	33,232.20 (30,898.92)	24,272.02 (42,134.24)
Total care costs	343	32,177.34 (31,836.95)	21,093.34 (43,201.84)

Abbreviations: IQR, interquartile range; SD, standard deviation.

Table 5 Resource use and costs results by DS score categories

Variable/analysis	Direct medical care costs (€)	Social care costs (€)	Indirect care costs (€)	Informal care costs (€)	Total care costs (€)
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
DS score 0–6	624.72 (927.62)	138.42 (1,174.72)	374.20 (1,754.42)	13,865.91 (18,283.65)	13,334.24 (18,173.95)
DS score 7–8	773.10 (1,009.94)	835.12 (2,893.40)	494.32 (1,601.22)	28,277.11 (23,039.32)	27,403.14 (23,392.70)
DS score 9–10	1,176.21 (1,413.43)	1,147.83 (3,123.94)	481.03 (1,376.85)	38,690.43 (29,892.31)	38,067.14 (31,011.92)
DS score 11–15	1,722.31 (2,729.53)	1,432.45 (3,059.80)	543.43 (1,811.84)	57,833.55 (33,612.82)	56,133.82 (37,284.33)
P-value	P<0.001b,c,d	P<0.001a–c,d	P=0.9	P<0.001a–c,d,e	P<0.001a–c,d,e

Notes: Unit costs are presented in € 2013. Statistic differences (Mann–Whitney with Bonferroni correction: level =0.05/6≅0.008).

a DS score 0–6 and DS score 7–8;

b DS score 0–6 and DS score 9–10;

c DS score 0–6 and DS score 11–15;

d DS score 7–8 and DS score 11–15;

e DS score 9–10 and DS score 11–15; No significant differences were found between second and third group (Mann-Whitney with Bonferroni correction: level = 0.05/6 ≅ 0.008).

Abbreviations: SD, standard deviation; DS, Dependence Scale.

Table 6 Multivariate analysis results

Variable/model	Direct medical care costs	Social care costs	Indirect care costs	Informal care costs	Total care costs
	Beta	Beta	Beta	Beta	Beta
Constant	4.826**	−2.304	−0.388	−0.266	−3.879
DS	0.135**	0.253**	0.052	2.147**	1.856**
Years since diagnosis	−0.150**	0.058	−0.009	−0.026	−0.105
CIRS	0.064**	0.020	−0.069	0.155	0.126
Sex
Male (base category)	–	–	–	–	–
Female	−0.055	0.274	0.499	0.699	2.635*
Living in institutionalized settinga
No (base category)	–	–	–	–	–
Yes	−0.058	–	−2.562	−2.805	5.593
Living with caregiver
No (base category)	–	–	–	–	–
Yes	−0.066	−0.319	−1.013*	2.702*	0.073
Age	0.006	0.015	0.021	0.092	0.142

Notes:

* P=0.05;

** P=0.01.

a The effect covariate was not analyzed for social care costs as these are part of these costs and highly dependent on the covariate. – Indicates base category.

Abbreviations: CIRS, Cumulative Illness Rating Scale; DS, Dependence Scale.

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