Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-23T09:26:20.949Z Has data issue: false hasContentIssue false
  • English
  • Français

The economic impact of moderate stage Alzheimer's disease in Italy: evidence from the UP-TECH randomized trial

Published online by Cambridge University Press:  15 April 2015

Carlos Chiatti ,
Gianluca Furneri ,
Joseph M. Rimland ,
Federica Demma ,
Franco Bonfranceschi ,
Laura Cassetta ,
Filippo Masera ,
Antonio Cherubini ,
Andrea Corsonello  and
Fabrizia Lattanzio
...Show all authors
Carlos Chiatti
Affiliation:
Italian National Research Center on Aging (INRCA), Ancona, Italy
Gianluca Furneri
Affiliation:
Italian National Research Center on Aging (INRCA), Ancona, Italy
Joseph M. Rimland*
Affiliation:
Italian National Research Center on Aging (INRCA), Ancona, Italy
Federica Demma
Affiliation:
Italian National Research Center on Aging (INRCA), Ancona, Italy
Franco Bonfranceschi
Affiliation:
Italian National Research Center on Aging (INRCA), Ancona, Italy
Laura Cassetta
Affiliation:
Italian National Research Center on Aging (INRCA), Ancona, Italy
Filippo Masera
Affiliation:
Marche Regional Health Agency, Ancona, Italy
Antonio Cherubini
Affiliation:
Italian National Research Center on Aging (INRCA), Ancona, Italy
Andrea Corsonello
Affiliation:
Italian National Research Center on Aging (INRCA), Ancona, Italy
Fabrizia Lattanzio
Affiliation:
Italian National Research Center on Aging (INRCA), Ancona, Italy
*
Correspondence should be addressed to: Joseph M. Rimland, Italian National Research Center on Aging (INRCA), Ancona, Italy. Phone: +39-071-8004787; Fax: +39-071-35941. Email: j.rimland@inrca.it.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families.

Methods:

This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community.

Results:

The societal burden of AD, composed of public, patient, and informal care costs, was about €20,000/yr. Out of this, the cost borne by the public sector was €4,534/yr. The main driver of public cost was the national cash-for-care allowance (€2,324/yr), followed by drug prescriptions (€1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at €13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure.

Conclusion:

The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org (Trial Registration number: NCT01700556).

Keywords

cost analysisAlzheimer’s diseaseUP-TECHRCTcaregivercommunity-living
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 9 , September 2015 , pp. 1563 - 1572
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albert, M. S. et al. (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the national institute on aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7, 270–279.CrossRefGoogle ScholarPubMed
Barberger-Gateau, P., Commenges, D., Gagnon, M., Letenneur, L., Sauvel, C. and Dartigues, J. F. (1992). Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers. Journal of the American Geriatrics Society, 40, 1129–1134.Google Scholar
Belle, S. H. et al. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial. Annals of Internal Medicine, 145, 727–738.Google Scholar
Björkgren, M. A., Fries, B. E. and Shugarman, L. R. (2000). A Rug-III case-mix system for home care. Canadian Journal on Aging, 19, 106–125.Google Scholar
Black, B. S., Johnston, D., Rabins, P. V., Morrison, A., Lyketsos, C. and Samus, Q. M. (2013). Unmet needs of community-residing persons with dementia and their informal caregivers: findings from the maximizing independence at home study. Journal of the American Geriatrics Society, 61, 2087–2095.Google Scholar
Boada, M. et al. (1999). Costs of health care resources of ambulatory-care patients diagnosed with Alzheimer's disease in Spain. Medicina Clinica, 113, 690–695.Google Scholar
Cardano, M., Costa, G. and Demaria, M. (2004). Social mobility and health in the turin longitudinal study. Social Science & Medicine, 58, 1563–1574.Google Scholar
Cavallo, M. C. and Fattore, G. (1997). The economic and social burden of Alzheimer disease on families in the Lombardy region of Italy. Alzheimer Disease & Associated Disorders, 11, 184–190.Google Scholar
Chiatti, C., Di Rosa, M., Melchiorre, M. G., Manzoli, L., Rimland, J. M. and Lamura, G. (2013a). Migrant care workers as protective factor against caregiver burden: results from a longitudinal analysis of the EUROFAMCARE study in Italy. Aging & Mental Health, 17, 609–614.Google Scholar
Chiatti, C. et al. (2013b). The UP-TECH project, an intervention to support caregivers of Alzheimer's disease patients in Italy: study protocol for a randomized controlled trial. Trials, 14, 155.CrossRefGoogle ScholarPubMed
Chiatti, C. et al. (2015). The UP-TECH project, an intervention to support caregivers of Alzheimer's disease patients in Italy: preliminary findings on recruitment and caregiving burden in the baseline population. Aging & Mental Health, 19, 517–525.Google Scholar
Coon, D. W., Thompson, L., Steffen, A., Sorocco, K. and Gallagher-Thompson, D. (2003). Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. The Gerontologist, 43, 678–689.Google Scholar
Costa, N. et al. (2012). Methodological considerations in cost of illness studies on Alzheimer disease. Health Economics Review, 2, 18.Google Scholar
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–S16.Google Scholar
De Lillo, A. and Schizzerotto, A. (1985). La Valutazione Sociale delle Occupazioni. Una Scala di Stratificazione Occupazionale per l'Italia Contemporanea. Bologna, Italia: Il Mulino.Google Scholar
Erikson, R. (1984). Social class of men, women and families. Sociology, 18, 500–514.Google Scholar
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.Google Scholar
Folstein, M., Folstein, S. and Mchugh, P. (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Hirdes, J. et al. (2010). interRAI Contact Assessment (CA) Form and User's Manual, 9.2. Ann Arbor, MI: InterRAI.Google Scholar
Huisman, M., Kunst, A. E. and Mackenbach, J. P. (2003). Socioeconomic inequalities in morbidity among the elderly: a European overview. Social Science and Medicine, 57, 861–873.Google Scholar
Hurd, M. D., Martorell, P., Delavande, A., Mullen, K. J. and Langa, K. M. (2013). Monetary costs of dementia in the United States. The New England Journal of Medicine, 368, 1326–1334.Google Scholar
Hux, M. J., O’Brien, B. J., Iskedjian, M., Goeree, R., Gagnon, M. and Gauthier, S. (1998). Relation between severity of Alzheimer's disease and costs of caring. Canadian Medical Association Journal, 159, 457–465.Google Scholar
Jonsson, L. and Wimo, A. (2009). The cost of dementia in Europe: a review of the evidence, and methodological considerations. Pharmacoeconomics, 27, 391–403.Google Scholar
Jorm, A. F. and Jolley, D. (1998). The incidence of dementia: a meta-analysis. Neurology, 51, 728–733.Google Scholar
Knapp, M., Iemmi, V. and Romeo, R. (2013). Dementia care costs and outcomes: a systematic review. International Journal of Geriatric Psychiatry, 28, 551–561.CrossRefGoogle ScholarPubMed
Konig, H. H. et al. (2014). The costs of dementia from the societal perspective: is care provided in the community really cheaper than nursing home care? Journal of the American Medical Directors Association, 15, 117–126.Google Scholar
Leicht, H. et al. (2013). Predictors of costs in dementia in a longitudinal perspective. PLoS One, 8, e70018.Google Scholar
Leon, J., Cheng, C. K. and Neumann, P. J. (1998). Alzheimer's disease care: costs and potential savings. Health Affairs, 17, 206–216.Google Scholar
Lindholm, C., Gustavsson, A., Jonsson, L. and Wimo, A. (2013). Costs explained by function rather than diagnosis–results from the SNAC Nordanstig elderly cohort in Sweden. International Journal of Geriatric Psychiatry, 28, 454–462.CrossRefGoogle ScholarPubMed
Luppa, M., Heinrich, S., Angermeyer, M. C., Konig, H. H. and Riedel-Heller, S. G. (2008). Healthcare costs associated with recognized and unrecognized depression in old age. International Psychogeriatrics, 20, 1219–1229.Google Scholar
Marche (2010). DGR 1729 “Model convention of sheltered housing for older people” Marche Region Italy.Google Scholar
Marvardi, M. et al. (2005). The caregiver burden inventory in evaluating the burden of caregivers of elderly demented patients: results from a multicenter study. Aging Clinical and Experimental Research, 17, 46–53.CrossRefGoogle ScholarPubMed
Mcdaid, D. (2001). Estimating the costs of informal care for people with Alzheimer's disease: methodological and practical challenges. International Journal of Geriatric Psychiatry, 16, 400–405.Google Scholar
Mcdowell, I. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, 3rd edn. Oxford, New York: Oxford University Press.Google Scholar
Mckhann, G. M. et al. (2011). The diagnosis of dementia due to Alzheimer's disease: recommendations from the national institute on aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7, 263–269.Google Scholar
Morris, J. N., Fries, B. E. and Morris, S. A. (1999). Scaling ADLs within the MDS. The Journals of Gerontology, Series A: Biological Sciences & Medical Sciences, 54, M546–M553.Google Scholar
Novak, M. and Guest, C. (1989). Application of a multidimensional caregiver burden inventory. The Gerontologist, 29, 798–803.Google Scholar
Poss, J. W., Hirdes, J. P., Fries, B. E., Mckillop, I. and Chase, M. (2008). Validation of resource utilization groups version III for home care (RUG-III/HC): evidence from a Canadian home care jurisdiction. Medical Care, 46, 380–387.Google Scholar
Prince, M. (2004). Care arrangements for people with dementia in developing countries. International Journal of Geriatric Psychiatry, 19, 170–177.Google Scholar
Reisberg, B., Auer, S. R. and Monteiro, I. M. (1996). Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. International Psychogeriatrics, 8 (Suppl. 3), 301–308.Google Scholar
Schneider, J., Murray, J., Banerjee, S. and Mann, A. (1999). EUROCARE: a cross-national study of co-resident spouse carers for people with Alzheimer's disease: i–factors associated with carer burden. International Journal of Geriatric Psychiatry, 14, 651–661.Google Scholar
Schwarzkopf, L. et al. (2012). Excess costs of dementia disorders and the role of age and gender—an analysis of German health and long-term care insurance claims data. BMC Health Services Research, 12, 165.Google Scholar
Shutes, I. and Chiatti, C. (2012). Migrant workers and emerging care markets in italy and UK. Journal of European Social Policy, 22, 392–405.Google Scholar
Sink, K. M., Covinsky, K. E., Barnes, D. E., Newcomer, R. J. and Yaffe, K. (2006). Caregiver characteristics are associated with neuropsychiatric symptoms of dementia. Journal of the American Geriatrics Society, 54, 796–803.Google Scholar
Thies, W. and Bleiler, L. (2011). Alzheimer's disease facts and figures. Alzheimer's & Dementia, 7, 208–244.Google Scholar
Trabucchi, M. (1999). An economic perspective on Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 12, 29–38.Google Scholar
Vasiliadis, H. M., Dionne, P. A., Preville, M., Gentil, L., Berbiche, D. and Latimer, E. (2013). The excess healthcare costs associated with depression and anxiety in elderly living in the community. The American Journal of Geriatric Psychiatry, 21, 536–548.Google Scholar
Vitaliano, P., Zhang, J. and Scanlan, J. (2003). Is caregiving hazardous to one's physical health? A meta-analysis. Psychological Bulletin, 129, 946–972.CrossRefGoogle ScholarPubMed
WHO and ADI (2012). Dementia a Public Health Priority. Geneva: World Health Organization.Google Scholar
Wisniewski, S. R. et al. (2003). The resources for enhancing Alzheimer's caregiver health (reach): project design and baseline characteristics. Psychology and Aging, 18, 375–384.Google Scholar
Supplementary material: Image

Chiatti supplementary material

Figure S1

Download Chiatti supplementary material(Image)
Image 40.4 KB
Supplementary material: Image

Chiatti supplementary material

Figure S2

Download Chiatti supplementary material(Image)
Image 56.9 KB
Supplementary material: File

Chiatti supplementary material

Table S1

Download Chiatti supplementary material(File)
File 12.1 KB
Supplementary material: File

Chiatti supplementary material

Table S2

Download Chiatti supplementary material(File)
File 13.4 KB