Medical and nursing home costs: From cognitively unimpaired through dementia. Issue 3 (5th September 2021)

• Record Type: Journal Article
• Authors: Long, Kirsten Hall; Smith, Carin; Petersen, Ronald; Emerson, Jane; Ransom, Jeanine; Mielke, Michelle M.; Hass, Steven; Leibson, Cynthia
• Is Part Of: Alzheimer's & dementia. Volume 18:Issue 3(2022)
• Page Start: 393
• Page End: 407
• Publication Date: 2021-09-05
• Subjects: cognitive status -- cost -- dementia -- economics -- mild cognitive impairment -- nursing home; Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.12400
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Introduction: Efforts to model the cost‐effectiveness of managing/modifying cognitive impairment lack reliable, objective, baseline medical, and nursing‐home (NH) costs. Methods: A stratified‐random sample of Olmsted County, MN, residents ages 70–89 years (N = 3545), well‐characterized as cognitively unimpaired, mild cognitive impairment (MCI), or dementia, were followed forward ≤1 year in provider‐linked billing data and the Centers for Medicare & Medicaid Services NH assessments. Direct medical/nursing home/medical + NH costs were estimated. Costs were stratified by vital status and NH‐use intensity (NH days/follow‐up days [0%, 1% to 24%, 25% to 99%, and 100%]). Between‐category mean‐annual cost differences were adjusted for patient characteristics and follow‐up days. Results: Costs/follow‐up day distributions differed significantly across cognitive categories. Mean costs/follow‐up days were 2.5 to 18 times higher for decedents versus survivors. Among all persons with MCI, <9% with any NH use accounted for 18% of all total annual medical + NH costs. Adjusted‐between‐category comparisons revealed significantly higher medical and medical + NH costs for MCI versus cognitively unimpaired. Discussion: Cost‐effectiveness for managing/modifying both MCI and dementia should consider end‐of‐life costs and NH‐use intensity. Results can help inform cost‐effectiveness models, predict future‐care needs, and aid decision‐making by individuals/providers/payers/policymakers.