Incremental Healthcare Costs of Dementia and Cognitive Impairment in Community-Dwelling Older Adults: A Prospective Cohort Study

Kerry M Sheets, Howard A Fink, Lisa Langsetmo, Allyson M Kats, John T Schousboe, Kristine Yaffe, Kristine E Ensrud
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Abstract

Background Cognitive impairment and dementia are associated with higher healthcare costs; whether these increased costs are attributable to greater comorbidity burden is unknown. We sought to determine associations of cognitive impairment and dementia with subsequent total and sector-specific healthcare costs after accounting for comorbidities and to compare costs by method of case ascertainment. Methods Index examinations (2002-2011) of four prospective cohort studies linked with Medicare claims. 8,165 community-dwelling Medicare fee-for-service beneficiaries (4,318 women; 3,847 men). Cognitive impairment identified by self-or-proxy report of dementia and/or abnormal cognitive testing. Claims-based dementia and comorbidities derived from claims using Chronic Condition Warehouse algorithms. Annualized healthcare costs (2023 dollars) ascertained for 36 months following index examinations. Results 521 women (12.1%) and 418 men (10.9%) met criteria for cognitive impairment; 388 women (9%) and 234 men (6.1%) met criteria for claims-based dementia. After accounting for age, race, geographic region, and comorbidities, mean incremental costs of cognitive impairment versus no cognitive impairment in women (men) were $6,883 ($7,276) for total healthcare costs, $4,160 ($4,047) for inpatient costs, $1,206 ($1,587) for SNF costs, and $689 ($668) for HHC costs. Mean adjusted incremental total and inpatient costs associated with claims-based dementia were smaller in magnitude and not statistically significant. Mean adjusted incremental costs of claims-based dementia versus no claims-based dementia in women (men) were $759 ($1,251) for SNF costs and $582 ($535) for HHC costs. Conclusions Cognitive impairment is independently associated with substantial incremental total and sector-specific healthcare expenditures not fully captured by claims-based dementia or comorbidity burden.
社区居住老年人痴呆和认知障碍的增量医疗费用:一项前瞻性队列研究
背景认知障碍和痴呆与较高的医疗费用相关;这些增加的费用是否归因于更大的合并症负担尚不清楚。在考虑了合并症后,我们试图确定认知障碍和痴呆与随后的总医疗成本和特定部门医疗成本的关系,并通过病例确定的方法比较成本。方法对2002-2011年4项与医疗保险索赔相关的前瞻性队列研究进行索引检查。8,165名社区医疗保险按服务收费受益人(4,318名妇女;3847人)。通过自我或代理报告痴呆和/或异常认知测试确定认知障碍。基于索赔的痴呆和来自使用慢性病仓库算法索赔的合并症。指数检查后36个月内确定的年化医疗费用(2023美元)。结果女性521人(12.1%)、男性418人(10.9%)符合认知障碍标准;388名女性(9%)和234名男性(6.1%)符合基于索赔的痴呆标准。在考虑了年龄、种族、地理区域和合共病后,女性(男性)认知障碍与无认知障碍的平均增量成本为总医疗成本6,883美元(7,276美元)、住院成本4,160美元(4,047美元)、SNF成本1,206美元(1,587美元)和HHC成本689美元(668美元)。与索赔型痴呆相关的平均调整后增量总费用和住院费用在量级上较小,无统计学意义。女性(男性)基于索赔的痴呆与无索赔的痴呆的调整后平均增量成本SNF成本为759美元(1251美元),HHC成本为582美元(535美元)。结论:认知障碍与大量增量的总医疗保健支出和特定部门的医疗保健支出独立相关,而这些支出未被基于索赔的痴呆或合并症负担完全涵盖。
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