Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's
Tóm tắt
Alzheimer's disease (AD) is a neurodegenerative disorder incurring significant social and economic costs. This study uses a US administrative claims database to evaluate the effect of AD on direct healthcare costs and utilization, and to identify the most common reasons for AD patients' emergency room (ER) visits and inpatient admissions. Demographically matched cohorts age 65 and over with comprehensive medical and pharmacy claims from the 2003–2004 MEDSTAT MarketScan® Medicare Supplemental and Coordination of Benefits (COB) Database were examined: 1) 25,109 individuals with an AD diagnosis or a filled prescription for an exclusively AD treatment; and 2) 75,327 matched controls. Illness burden for each person was measured using Diagnostic Cost Groups (DCGs), a comprehensive morbidity assessment system. Cost distributions and reasons for ER visits and inpatient admissions in 2004 were compared for both cohorts. Regression was used to quantify the marginal contribution of AD to health care costs and utilization, and the most common reasons for ER and inpatient admissions, using DCGs to control for overall illness burden. Compared with controls, the AD cohort had more co-morbid medical conditions, higher overall illness burden, and higher but less variable costs ($13,936 s. $10,369; Coefficient of variation = 181 vs. 324). Significant excess utilization was attributed to AD for inpatient services, pharmacy, ER visits, and home health care (all p < 0.05). In particular, AD patients were far more likely to be hospitalized for infections, pneumonia and falls (hip fracture, syncope, collapse). Patients with AD have significantly more co-morbid medical conditions and higher healthcare costs and utilization than demographically-matched Medicare beneficiaries. Even after adjusting for differences in co-morbidity, AD patients incur excess ER visits and inpatient admissions.
Tài liệu tham khảo
Alzheimer's disease facts and figures 2007. Statistical abstract of US data on Alzheimer's disease published by the Alzheimer's Association. [http://www.alz.org/national/documents/report_alzfactsfigures2007.pdf]
Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA: Alzheimer disease in the U.S. population: prevalence estimates using the 2000 census. Archives of Neurology. 2003, 60 (8): 1119-1122. 10.1001/archneur.60.8.1119.
Saving lives, saving money: dividends for Americans investing in Alzheimer's research. Report of the Lewin Group to the Alzheimer's Association. 2004. [http://www.alz.org/national/documents/report_savinglivessavingmoney.pdf]
Gutterman EM, Markowitz JS, Lewis B, Fillit H: Cost of Alzheimer's disease and related dementia in managed Medicare. J Am Geriatr Soc. 1999, 47 (9): 1065-1071.
Menzin J, Lang K, Friedman M, Neumann P, Cummings JL: The economic cost of Alzheimer's disease and related dementias to the California Medicaid Program ("Medi-Cal") in 1995. Am J Geriatr Psychiatry. 1999, 7 (4): 300-308.
Martin BC, Ricci JF, Kotzan JA, Lang K, Menzin J: The net cost of Alzheimer disease and related dementia: a population-based study of Georgia Medicaid recipients. Alzheimer Dis Assoc Disord. 2000, 14 (3): 151-159. 10.1097/00002093-200007000-00006.
Fillit H, Hill JW, Futterman R: Health care utilization and costs of Alzheimer's disease: the role of comorbid conditions, disease stage, and pharmacotherapy. Fam Med. 2002, 34 (7): 528-535.
Hill JW, Futterman R, Duttagupta S, Mastey V, Lloyd JR, Fillit H: Alzheimer's disease and related dementias increase costs of comorbidities in managed Medicare. Neurology. 2002, 58 (1): 62-70.
Sloan FA, Taylor DH: Effect of Alzheimer's disease on the cost of treating other diseases. Alzheimer Dis Assoc Disord. 2002, 16 (3): 137-143. 10.1097/00002093-200207000-00002.
Weiner M, Powe NR, Weller WE, Shaffer TJ, Anderson GF: Alzheimer's disease under managed care: implications from Medicare utilization and expenditure patterns. J Am Geriatr Soc. 1998, 46 (6): 762-770.
Newcomer R, Clay T, Luxenberg JS, Miller RH: Misclassification and selection bias when identifying Alzheimer's disease solely from Medicare claims records. J Am Geriatr Soc. 1999, 47 (2): 215-219.
Richards KM, Shepherd MD, Crimson ML, Snyder EH, Jermain DM: Medical services utilization and charge comparisons between elderly patients with and without Alzheimer's disease in a managed care organization. Clin Ther. 2000, 22 (6): 775-791. 10.1016/S0149-2918(00)90011-0.
Frytak JR, Henk HJ, Zhao Y: Health service utilization among Alzheimer's patients: evidence from managed care. Alzheimer's & Dementia.
Joyce AT, Zhao Y, Bowman L, Flynn JA, Carter CT, Ollendorf TA: Burden of illness among patients with Alzheimer's disease in a commercially-insured population. Alzheimer's & Dementia. 2007, 3 (3): 204-210. 10.1016/j.jalz.2007.04.373.
McCormick WC, Hardy J, Kukull WA, Bowen JD, Teri L, Zitzer S, Larson EB: Healthcare utilization and costs in managed care patients with Alzheimer's Disease during the last few years of life. J Am Geriatr Soc. 2001, 49 (9): 1156-1160. 10.1046/j.1532-5415.2001.49231.x.
Leibson C, Tomas O, O'Brien P, Waring S, Tangalos E, Hanson V, Plevack M, Kokmen E: Use of physician and acuter care services by persons with and without Alzheimer's Disease: A population-based comparison. J Am Geriatr Soc. 1999, 47 (7): 864-869.
Ash AS, Ellis RP, Pope GC, Ayanian JZ, Bates DW, Burstin H, Iezzoni LI, MacKay E, Yu W: Using diagnoses to describe populations and predict costs. Health Care Financ Rev. 2000, 21 (3): 7-28.
Zhao Y, Ash AS, Ellis RP, Ayanian JZ, Pope GC, Bowen B, Weyuker L: Predicting pharmacy costs and other medical costs using diagnoses and drug claims. Medical Care. 2005, 43 (1): 34-43.
Kuo T, Zhao Y, Weir S, Kramer MS, Ash AS: Implications of comorbidity on costs for patients with Alzheimer's disease. Medical Care.
Lacro JP, Jeste DV: Physical comorbidity and polypharmacy in older psychiatric patients. Biological Psychiatry. 1994, 36 (3): 146-152. 10.1016/0006-3223(94)91220-3.
Stewart RB, Cooper JW: Polypharmacy in the aged. Practical solutions. Drugs Aging. 1994, 4 (6): 449-461. 10.2165/00002512-199404060-00002.
Nolan L, O'Malley K: Prescribing for the elderly: part 1. Sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc. 1988, 36 (3): 142-149.
Colt HG, Shapiro AP: Drug-induced illness as a cause for admission to a community hospital. J Am Geriatr Soc. 1989, 37 (4): 323-326.
Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BV, Breckenridge AM: Adverse drug reactions as a cause for admission to hospital: prospective analysis of 18820 patients. Br Med J. 2004, 329 (7456): 15-19. 10.1136/bmj.329.7456.15.
Fattinger K, Roos M, Vergeres P, Holenstein C, Kind B, Masche U, Stocker DN, Braunschweig S, Kullak-Ublick GA, Galeazzi RL, Follath F, Gasser T, Meier PJ: Epidemiology of drug exposure and adverse drug reactions in two Swiss departments of internal medicine. Br J Clin Pharmacol. 2000, 49 (2): 158-167. 10.1046/j.1365-2125.2000.00132.x.
Feldman H, Gracon S: Alzheimer's disease: symptomatic drugs under development. Clinical Diagnosis and Management of Alzheimer's disease. Edited by: Serge Gauthier. 1996, London. Informa UK limited, 236-259.
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