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Economics of Dementia. Julie Bynum, MD MPH December 7, 2010. Disease Specific Costs. Why Discuss them?. Alzheimer’s Research Trust, 2010. Stella Marr’s postcard. Alzheimer’s Research Trust, 2010. To Lobby for More Research Funding.

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Economics of dementia

Economics of Dementia

Julie Bynum, MD MPH

December 7, 2010


Disease specific costs
Disease Specific Costs

  • Why Discuss them?



Stella Marr’s postcard

Alzheimer’s Research Trust, 2010

To Lobby for More Research Funding




Medicare Part A (Health Insurance) future Trust Fund Balance, 2001-2018Under High Cost, Low Cost, and Intermediate Assumptions

Fund balance as % of

annual expenditures:

ActualProjected

Low cost

Intermediate

High cost

NOTE: The Medicare Trustees recommend that the HI Trust Fund assets should be maintained at a level of at least 100% of annual expenditures. SOURCE: Kaiser Family Foundation based on 2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.


Bottom line
Bottom Line future

Direct Dementia Care Costs are three times the Cost of Other Chronic Illnesses.

We currently deliver care in an expensive way that might be less costly and better quality in a different model.


How are dementia costs different from other diseases? future

Alzheimer’s Research Trust, 2010


EXAMPLES future

Health

Medical

Psychiatric & Behavioral

Supervision

Social

Safe housing

Functional Supports (eating, dressing etc)

Informal Care

Spousal support

Unpaid caregiving

Productivity loss

Reduced hours due to informal care giving

“Sandwich Generation”



Direct costs
Direct Costs diseases.

Who are the stakeholders?

Alt. (Who pays the bills?)


Community diseases.

Nursing home

HOSPITAL

Assisted Living


   diseases.

  

  

  

  

  

  

  

Community

Local Care System

HHA

HOSPITAL

SNF

Nursing home

  

  

  

  

  

  

Clinic

Assisted Living

  

  

  

  


Transitions

Community diseases.

Nursing home

Assisted Living

Funding Transitions

Assisted Living

Nursing home

HOSPITAL

Private Pay

Medicare

Private Pay

Medicaid

Medicare SNF

Transitions

HOSPITAL


Expenditures community vs institution in dementia
Expenditures diseases.Community vs. Institution in Dementia

Bynum, Unadjusted Data MCBS 2004


Expenditures diseases.Community vs. Institution in Dementia

Bynum, Unadjusted Data MCBS 2004


Expenditures compared to other diseases
Expenditures Compared to Other Diseases diseases.

Bynum, Unadjusted Data MCBS 2004


Expenditures Compared to Other Diseases diseases.

Bynum, Unadjusted Data MCBS 2004


Expenditures Compared to Other Diseases diseases.

Bynum, Unadjusted Data MCBS 2004


Expenditures Compared to Other Diseases diseases.

Bynum, Unadjusted Data MCBS 2004


Difficulty comparing costs to other diseases
Difficulty Comparing Costs to Other Diseases diseases.

  • Avg. 4 chronic conditions compared to 1 without dementia.

Bynum, Unadjusted Data MCBS 2004


Hospitalization
Hospitalization diseases.

In Medicare approximately 50% of costs are for hospital care.


Ask ourselves why
Ask ourselves why? diseases.

  • Behavioral issues/psychiatric admissions

  • Inability to self manage chronic disease

  • Caregiver stress and burnout

  • Clinician uncertainties about diagnosis and management


Biopsychosocial model of health
Biopsychosocial diseases. Model of Health

Psychological

Social

Physical

Engel, 1977


Biopsychosocial model of costs for the dementia patient
Biopsychosocial diseases.Model of Costs for the Dementia Patient

Psychological

Social

Physical


Consider how costs might be different in the future
Consider how costs might be different diseases. in the future


Consider how costs might be different diseases. in the future

Current


How much does social care cost
How Much Does diseases. Social Care Cost?

2010 Median Annual Rate for the US

Nursing home (private rm): $75,190

Nursing home (semi-private rm): $67,525

Assisted Living (1Br-single): $38,220

Home Health Aide: $43,472

Home Maker Services: $41,184

Adult Day Care: $15,600

Genworth Report 2010


What if we delayed progression of disease
What if we delayed progression of disease? diseases.

  • Delay progression reduces number in late stage of disease with high social and informal care costs

  • Cost argument current medications



What if we delayed onset of disease
What if we delayed onset of disease? diseases.

  • By 2050, estimates number of cases 4x higher based on current incidence rates

  • If disease onset could be delayed, how much would be saved after 10 yrs?

    • 1-yr: save $10 Billion annually

    • 6-mo: save $4.7 Billion annually

Brookmeyer, AJPH 1998



A Family Intervention to Delay Nursing Home Placement of Patients with Alzheimer’s Disease: A Randomized Controlled TrialMittelman MS et al. JAMA 1996;276:1725.

Sample: Referred, volunteer 206 spouse-caregivers of AD pts living at home with > 1 relative in area

Intervention enrolled over 3.5 yrs:

Indiv. & Family counseling: task oriented, teaching techniques for problem solving, improve communication and support of primary caregiver

Caregivers joined a support group (any)

24 hr available counselor for crises or questions

F/u up to 8 years

Funding: NIMH


Results delay of institutionalization 329 days
Results: Delay of Patients with Alzheimer Institutionalization 329 Days

Mittelman MS et al. JAMA 276:1725-1731, 1996


Interventions studied to delay nursing home placement in people with alzheimer s disease
Interventions Patients with AlzheimerStudied to Delay Nursing Home Placement in People with Alzheimer’s Disease

Spouse-Caregiver Intervention

Drug Study: Donepezil

No Effect on Nursing Home

Delay Placement by 329 Days

AD2000 Collaborative Group Lancet 2004;363:2105-15.

Mittelman MS et al. JAMA 276:1725-1731, 1996


Costs of two interventions estimates since no published data
Costs of Two Patients with AlzheimerInterventions(Estimates since no published data)

Caregiver Intervention

2.4 FTE counselor with 85pt caseload

Salary 35-45K/yr inflated for benefits

$1280-1600/patient/yr

Drug Intervention

Donepezil $1560/pt/yr

Added cost

329 days in Nursing Home = $43,428/pt


NH Patients with Alzheimer

30%

Home/AL

70%

Where Do People With

Alzheimer’s Disease Live?

Source: Alzheimer’s Association, 2004


“Not Patients with Alzheimereverything that counts can be counted, and not everything that can be counted counts.”

Albert Einstein


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