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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?
slide5
Stella Marr’s postcard

Alzheimer’s Research Trust, 2010

To Lobby for More Research Funding

slide16
Medicare Part A (Health Insurance) 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

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.

slide19
EXAMPLES

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

Who are the stakeholders?

Alt. (Who pays the bills?)

slide22
Community

Nursing home

HOSPITAL

Assisted Living

slide23
  

  

  

  

  

  

  

  

Community

Local Care System

HHA

HOSPITAL

SNF

Nursing home

  

  

  

  

  

  

Clinic

Assisted Living

  

  

  

  

transitions
Community

Nursing home

Assisted Living

Funding Transitions

Assisted Living

Nursing home

HOSPITAL

Private Pay

Medicare

Private Pay

Medicaid

Medicare SNF

Transitions

HOSPITAL

expenditures compared to other diseases
Expenditures Compared to Other Diseases

Bynum, Unadjusted Data MCBS 2004

slide28
Expenditures Compared to Other Diseases

Bynum, Unadjusted Data MCBS 2004

slide29
Expenditures Compared to Other Diseases

Bynum, Unadjusted Data MCBS 2004

slide30
Expenditures Compared to Other Diseases

Bynum, Unadjusted Data MCBS 2004

difficulty comparing costs to other diseases
Difficulty Comparing Costs to Other Diseases
  • Avg. 4 chronic conditions compared to 1 without dementia.

Bynum, Unadjusted Data MCBS 2004

hospitalization
Hospitalization

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

ask ourselves why
Ask ourselves why?
  • 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 Model of Health

Psychological

Social

Physical

Engel, 1977

how much does social care cost
How Much Does 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?
  • 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?
  • 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

slide43
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 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 Studied 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 Interventions(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

slide47
NH

30%

Home/AL

70%

Where Do People With

Alzheimer’s Disease Live?

Source: Alzheimer’s Association, 2004

slide48
“Not everything that counts can be counted, and not everything that can be counted counts.”

Albert Einstein

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