What Drives Country Differences in Cost of Alzheimer’s Disease? An Explanation from Resource Use in the GERAS Study

Article type: Research Article

Authors: Reed, Catherine^{a; *} | Happich, Michael^b | Argimon, Josep Maria^c | Haro, Josep Maria^d | Wimo, Anders^{e; f} | Bruno, Giuseppe^g | Dodel, Richard^h | Jones, Roy W.ⁱ | Vellas, Bruno^j | Belger, Mark^a

Affiliations: [a] Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK | [b] Lilly Deutschland GmbH, Bad Homburg, Germany | [c] Divisió d’avaluació, Servei Català de la Salut, Barcelona, Spain | [d] Parc Santari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain | [e] KI Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden | [f] Centre for Research and Development, Uppsala University/Region of Gavleborg, Gävle, Sweden | [g] Clinica della Memoria, Department of Neurology & Psychiatry, University of Rome “Sapienza”, Rome, Italy | [h] Department of Neurology, Philipps-University, Marburg, Germany | [i] RICE (The Research Institute for the Care of Older People), >The RICE Centre, Royal United Hospital, Bath, UK | [j] Gerontopole, Alzheimer’s Disease Research and Clinical Care, INSERM 1027, Toulouse University Hospital, Toulouse, France

Correspondence: [*] Correspondence to: Catherine Reed, Global Health Outcomes, Eli Lilly and Company, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH, UK. Tel.: +44 1276 483243; Fax: +44 1276 483192; E-mail: [email protected].

Abstract: Background: Country differences in resource use and costs of Alzheimer’s disease (AD) may be driven by differences in health care systems and resource availability. Objective: To compare country resource utilization drivers of societal costs for AD dementia over 18 months. Methods: GERAS is an observational study in France (n = 419), Germany (n = 550), and the UK (n = 526). Resource use of AD patients and caregivers contributing to >1% of total societal costs (year 2010) was assessed for country differences, adjusting for participant characteristics. Results: Mean 18-month societal costs per patient were France €33,339, Germany €38,197, and UK €37,899 (£32,501). Caregiver time spent on basic and instrumental activities of daily living (ADL) contributed the most to societal costs (54% France, 64% Germany, 65% UK). Caregivers in France spent less time on ADL than UK caregivers and missed fewer work days than in other countries. Compared with other countries, patients in France used more community care services overall and were more likely to use home aid. Patients in Germany were least likely to use temporary accommodation or to be institutionalized at 18 months. UK caregivers spent the most time on instrumental ADL, UK patients used fewest outpatient resources, and UK patients/caregivers were most likely to receive financial support. Conclusion: Caregiver time on ADL contributed the most to societal costs and differed across countries, possibly due to use of community care services and institutionalization. Other resources had different patterns of use across countries, reflecting country-specific health and social care systems.

Keywords: Activities of daily living, Alzheimer’s disease, caregivers, costs, health resources

DOI: 10.3233/JAD-160449

Journal: Journal of Alzheimer's Disease, vol. 57, no. 3, pp. 797-812, 2017