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Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease

From the Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness (C.W.Z., M.S.), Targeted Research Enhancement Program, Bronx VA Medical Center, Bronx, NY; Brookdale Department of Geriatrics (C.W.Z.) and Department of Psychiatry (M.S.), Mount Sinai School of Medicine, New York, NY; Cognitive Neuroscience Division of the Taub Institute for Research in Alzheimer’s Disease and the Aging Brain (N.S., R.T., Y.S.), Gertrude H. Sergievsky Center and the Department of Neurology, Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences (M.A., J.B.), Johns Hopkins University, Baltimore, MD; and Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Dr. Carolyn Zhu, Geriatric Research, Education, and Clinical Center, Bronx VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468; e-mail: carolyn.zhu{at}mssm.edu

Objectives: To estimate long-term trajectories of direct cost of caring for patients with Alzheimer disease (AD) and examine the effects of patients’ characteristics on cost longitudinally.

Methods: The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed up annually for up to 7 years in three university-based AD centers in the United States. Random effects models estimated the effects of patients’ clinical and sociodemographic characteristics on direct cost of care. Direct cost included cost associated with medical and nonmedical care. Clinical characteristics included cognitive status (measured by Mini-Mental State Examination), functional capacity (measured by Blessed Dementia Rating Scale [BDRS]), psychotic symptoms, behavioral problems, depressive symptoms, extrapyramidal signs, and comorbidities. The model also controlled for patients’ sex, age, and living arrangements.

Results: Total direct cost increased from approximately $9,239 per patient per year at baseline, when all patients were at the early stages of the disease, to $19,925 by year 4. After controlling for other variables, a one-point increase in the BDRS score increased total direct cost by 7.7%. One more comorbid condition increased total direct cost by 14.3%. Total direct cost was 20.8% lower for patients living at home compared with those living in an institutional setting.

Conclusions: Total direct cost of caring for patients with Alzheimer disease increased substantially over time. Much of the cost increases were explained by patients’ clinical and demographic variables. Comorbidities and functional capacity were associated with higher direct cost over time.

This article was previously published in electronic format as an Expedited E-Pub on August 16, 2006, at www.neurology.org.

The Predictors Study is supported by Federal grants AG07370, RR00645, and U01AG010483. Drs. Zhu and Sano also are supported by the Department of Veterans Affairs, Veterans Health Administration. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Disclosure: The authors report no conflicts of interest.

Received January 27, 2006. Accepted in final form April 11, 2006.

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