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The Cost of Dementia in Europe

A Review of the Evidence, and Methodological Considerations

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Abstract

Alzheimer’s disease (AD) is a leading cause of disability in the elderly, leading to a high burden on caregivers and costs to society. This article describes the current level of data availability regarding the costs of AD in Europe, summarizes and compares findings from previous studies in different countries, and discusses the applicability of available data for modelling purposes.

A literature review was conducted for papers in any language reporting data on costs of care for patients with diagnosed dementia or possible/probable AD. Only papers reporting patient-level data on costs were included. A total of 16 studies were identified: from the Nordic region (4), the UK (3), Spain (3), France (2), Italy (2), Belgium (1) and Germany (1). There is large variation in total cost estimates, depending on, for example, differences in study methodology, setting, type and severity of patients included, range of costs assessed and the choice of principle for valuing informal care. The median value for total annual care costs in all studies was €28 000 (range €6614–€64 426) [year 2005 values]. Few studies assessed aspects of disease severity other than cognitive function.

The costs of AD in Europe are substantial and increase with disease severity. Methodological differences between studies make comparison across countries and healthcare systems difficult, and there is a need to standardize methods for assessing and valuing informal care. Patient-level information on resource use is required to analyse determinants of care costs and predict the impact of therapeutic interventions. More data are needed to support future economic evaluations of therapies for AD.

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References

  1. Andlin-Sobocki P, Jönsson B, Wittchen HU, et al. Cost of disorders of the brain in Europe. Eur J Neurol 2005; 12 Suppl. 1: 1–27

    Article  PubMed  Google Scholar 

  2. Wimo A, Jönsson L, Winblad B. An estimate of the worldwide prevalence and direct costs of dementia in 2003. Dement Geriatr Cogn Disord 2006; 21 (3): 175–81

    Article  PubMed  CAS  Google Scholar 

  3. Fratiglioni L, Launer LJ, Andersen K, et al. Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000; 54 (11 Suppl. 5): S10–5

    Google Scholar 

  4. Klafki HW, Staufenbiel M, Kornhuber J, et al. Therapeutic approaches to Alzheimer’s disease. Brain 2006; 129 (Pt 11): 2840–55

    Article  PubMed  Google Scholar 

  5. Wimo A, Jönsson L. Societal costs of dementia [in Swedish]. Stockholm: Socialstyrelsen, 2000

    Google Scholar 

  6. Green C. Modelling disease progression in Alzheimer’s disease: a review of modelling methods used for cost-effectiveness analysis. Pharmacoeconomics 2007; 25 (9): 735–50

    Article  PubMed  Google Scholar 

  7. Jönsson L. Pharmacoeconomics of cholinesterase inhibitors in the treatment of Alzheimer’s disease. Pharmacoeconomics 2003; 21 (14): 1025–37

    Article  PubMed  Google Scholar 

  8. Jönsson L, Eriksdotter Jönhagen M, Kilander L, et al. Determinants of costs of care for patients with Alzheimer’s disease. Int J Ger Psych 2006 May; 21 (5): 449–59

    Article  Google Scholar 

  9. Jönsson L, Berr C. Cost of dementia in Europe. Eur J Neurol 2005; 12 Suppl. 1: 50–3

    Article  PubMed  Google Scholar 

  10. Scuvee-Moreau J, Kurz X, Dresse A. The economic impact of dementia in Belgium: results of the National Dementia Economic Study (NADES). Acta Neurol Belg 2002; 102 (3): 104–13

    PubMed  CAS  Google Scholar 

  11. Souêtre EJ, Qing W, Vigoureux I, et al. Economic analysis of Alzheimer’s disease in outpatients: impact of symptom severity. Int Psychogeriatr 1995; 7 (1): 115–22

    Article  PubMed  Google Scholar 

  12. Rigaud AS, Fagnani F, Bayle C, et al. Patients with Alzheimer’s disease living at home in France: costs and consequences of the disease. J Geriatr Psychiatry Neurol 2003; 16 (3): 140–5

    Article  PubMed  Google Scholar 

  13. Cavallo MC, Fattore G. The economic and social burden of Alzheimer disease on families in the Lombardy region of Italy. Alzheimer Dis Assoc Disord 1997; 11 (4): 184–90

    PubMed  CAS  Google Scholar 

  14. Trabucchi M. An economic perspective on Alzheimer’s disease. J Geriatr Psychiatry Neurol 1999; 12 (1): 29–38

    Article  PubMed  CAS  Google Scholar 

  15. Kronborg Andersen C, Søgaard J, Hansen E, et al. The cost of dementia in Denmark: the Odense Study. Dement Geriatr Cogn Disord 1999; 10 (4): 295–304

    Article  PubMed  CAS  Google Scholar 

  16. Atance Martinez JC, Yusta Izquierdo A, Grupeli Gardel BE. Costs study in Alzheimer’s disease [in Spanish]. Rev Clin Esp 2004; 204 (2): 64–9

    Article  PubMed  CAS  Google Scholar 

  17. Boada M, Peña-Casanova J, Bermejo F, et al. Costs of health care resources of ambulatory-care patients diagnosed with Alzheimer’s disease in Spain [in Spanish]. Med Clin (Barc) 1999; 113 (18): 690–5

    CAS  Google Scholar 

  18. Lopez-Bastida J, Serrano-Aguilar P, Perestelo-Perez L, et al. Social-economic costs and quality of life of Alzheimer disease in the Canary Islands, Spain. Neurology 2006; 67 (12): 2186–91

    Article  PubMed  Google Scholar 

  19. Souêtre E, Thwaites RM, Yeardley HL. Economic impact of Alzheimer’s disease in the United Kingdom: cost of care and disease severity for non-institutionalised patients with Alzheimer’s disease. Br J Psychiatry 1999; 174: 51–5

    Article  PubMed  Google Scholar 

  20. Wolstenholme J, Fenn P, Gray A, et al. Estimating the relationship between disease progression and cost of care in dementia. Br J Psychiatry 2002; 181: 36–42

    Article  PubMed  CAS  Google Scholar 

  21. Livingston G, Katona C, Roch B, et al. A dependency model for patients with Alzheimer’s disease: its validation and relationship to the costs of care. The LASER-AD Study. Curr Med Res Opin 2004; 20 (7): 1007–16

    Article  PubMed  CAS  Google Scholar 

  22. Schulenberg J, Schulenberg I, Horn R. Cost of treatment and cost of care for Alzheimer’s disease in Germany. In: Wimo A, Jönsson B, Karlsson G, et al., editor. The health economics of dementia. Chichester: John Wiley & Sons, 1998: 217–30

    Google Scholar 

  23. Plosker GL, Lyseng-Williamson KA. Memantine: a pharmacoeconomic review of its use in moderate-to-severe Alzheimer’s disease. Pharmacoeconomics 2005; 23 (2): 193–206

    Article  PubMed  Google Scholar 

  24. HEED: Health Economics Evaluations Database. London: Office of Health Economics, 2005. (Data on file)

  25. Jones RW, McCrone P, Guilhaume C. Cost effectiveness of memantine in Alzheimer’s disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging 2004; 21 (9): 607–20

    Article  PubMed  CAS  Google Scholar 

  26. Jönsson L. Cost-effectiveness of memantine for moderate to severe Alzheimer’s disease in Sweden. Am J Geriatr Pharmacother 2005; 3 (2): 77–86

    Article  PubMed  Google Scholar 

  27. Jönsson L, Lindgren P, Wimo A, et al. The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer’s disease: a Markov model. Clin Ther 1999; 21 (7): 1230–40

    Article  PubMed  Google Scholar 

  28. Francois C, Sintonen H, Sulkava R, et al. Cost effectiveness of memantine in moderately severe to severe Alzheimer’s disease: a Markov model in Finland. Clin Drug Invest 2004; 24 (7): 373–84

    Article  CAS  Google Scholar 

  29. Rahkonen T, Eloniemi-Sulkava U, Rissanen S, et al. Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older. J Neurol Neurosurg Psychiatry 2003; 74 (6): 720–4

    Article  PubMed  CAS  Google Scholar 

  30. Fratiglioni L, Viitanen M, Bäckman L, et al. Occurrence of dementia in advanced age: the study design of the Kungsholmen Project. Neuroepidemiology 1992; 11 Suppl. 1: 29–36

    Article  PubMed  Google Scholar 

  31. Feldman H, Gauthier S, Hecker J, et al. Economic evaluation of donepezil in moderate to severe Alzheimer disease. Neurology 2004; 63 (4): 644–50

    Article  PubMed  CAS  Google Scholar 

  32. Wimo A, Winblad B, Stoffler A, et al. Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer’s disease. Pharmacoeconomics 2003; 21 (5): 327–40

    Article  PubMed  CAS  Google Scholar 

  33. Courtney C, Farrell D, Gray R, et al. Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomised double-blind trial. Lancet 2004; 363 (9427): 2105–15

    Article  PubMed  CAS  Google Scholar 

  34. Wimo A, Winblad B, Engedal K, et al. An economic evaluation of donepezil in mild to moderate Alzheimer’s disease: results of a 1-year, double-blind, randomized trial. ement Geriatr Cogn Disord 2003; 15 (1) 44–54

    Article  CAS  Google Scholar 

  35. Data on file, OECD.Stat database, OECD, 2006

  36. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12 (3): 189–98

    Article  PubMed  CAS  Google Scholar 

  37. Andersen CK, Lauridsen J, Andersen K, et al. Cost of dementia: impact of disease progression estimated in longitudinal data. Scand J Public Health 2003; 31 (2): 119–25

    Article  PubMed  Google Scholar 

  38. Jönsson L, Lindgren P, Wimo A, et al. Costs of MMSE-related cognitive impairment. Pharmacoeconomics 1999; 16 (4): 409–16

    Article  PubMed  Google Scholar 

  39. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Mol State Med J 1965 Feb; 14: 61–5

    CAS  Google Scholar 

  40. McDaid D. Estimating the costs of informal care for people with Alzheimer’s disease: methodological and practical challenges. Int J Geriatr Psychiatry 2001; 16 (4): 400–5

    Article  PubMed  CAS  Google Scholar 

  41. Nordberg G, Wimo A, Jönsson L, et al. Time use and costs of institutionalised elderly persons with or without dementia: results from the Nordanstig cohort in the Kungsholmen Project. A population based study in Sweden. Int J Geriatr Psychiatry 2007 Jul; 22 (7): 639–48

    Article  PubMed  Google Scholar 

  42. Kirk A. Target symptoms and outcome measures: cognition. Can J Neurol Sci 2007 Mar; 34 (Suppl. 1): S42–6

    Google Scholar 

Download references

Acknowledgements

This work was supported by a grant from Wyeth Research. The study was carried out independently of the funder. The authors confirm that the paper is an accurate representation of the results. The paper has benefited from comments from Arthur Zbrozek and two anonymous referees. Both authors have acted as consultants for a number of pharmaceutical companies with products for Alzheimer’s disease.

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Correspondence to Linus Jönsson.

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Jönsson, L., Wimo, A. The Cost of Dementia in Europe. Pharmacoeconomics 27, 391–403 (2009). https://doi.org/10.2165/00019053-200927050-00004

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