Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-19T01:47:24.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Healthcare resource utilization and cost in dementia: are there differences between patients screened positive for dementia with and those without a formal diagnosis of dementia in primary care in Germany?‡

Published online by Cambridge University Press:  22 September 2015

Bernhard Michalowsky ,
Tilly Eichler ,
Jochen René Thyrian ,
Johannes Hertel ,
Diana Wucherer ,
Wolfgang Hoffmann  and
Steffen Flessa
Bernhard Michalowsky*
Affiliation:
German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
Tilly Eichler
Affiliation:
German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
Jochen René Thyrian
Affiliation:
German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
Johannes Hertel
Affiliation:
German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
Diana Wucherer
Affiliation:
German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
Wolfgang Hoffmann
Affiliation:
German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany Institute for Community Medicine, Section Epidemiology of HealthCare and Community Health, Ernst-Moritz-Arndt-University Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
Steffen Flessa
Affiliation:
Department of HealthCare Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University Greifswald, Friedrich-Loeffler-Strasse 70, Greifswald, Germany
*
Correspondence should be addressed to: Bernhard Michalowsky, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17487, Germany. Phone: +49 3834 86 7591. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

It is well-known that dementia is undiagnosed, resulting in the exclusion of patients without a formal diagnosis of dementia in many studies. Objectives of the present analyses were (1) to determine healthcare resource utilization and (2) costs of patients screened positive for dementia with a formal diagnosis and those without a formal diagnosis of dementia, and (3) to analyze the association between having received a formal dementia diagnosis and healthcare costs.

Method:

This analysis is based on 240 primary care patients who screened positive for dementia. Within the baseline assessment, individual data about the utilization of healthcare services were assessed. Costs were assessed from the perspective of insurance, solely including direct costs. Associations between dementia diagnosis and costs were evaluated using multiple linear regression models.

Results:

Patients formally diagnosed with dementia were treated significantly more often by a neurologist, but less often by all other outpatient specialists, and received anti-dementia drugs and day care more often. Diagnosed patients underwent shorter and less frequent planned in-hospital treatments. Dementia diagnosis was significantly associated with higher costs of anti-dementia drug treatment, but significantly associated with less total medical care costs, which valuated to be € 5,123 compared, to € 5,565 for undiagnosed patients. We found no association between dementia diagnosis and costs of evidence-based non-medication treatment or total healthcare cost (€ 7,346 for diagnosed vs. € 6,838 for undiagnosed patients).

Conclusion:

There are no significant differences in total healthcare cost between diagnosed and undiagnosed patients. Dementia diagnosis is beneficial for receiving cost-intensive anti-dementia drug treatments, but is currently insufficient to ensure adequate non-medication treatment for community-dwelling patients.

Keywords

dementiaAlzheimer's diseasediagnosiscost of illnesseconomicshealthcare utilization
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 3 , March 2016 , pp. 359 - 369
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.)

Footnotes

‡

The original version of this article was published with an author incorrectly omitted. A notice detailing this has been published and the error rectified in the online and print PDF and HTML copies.

References

Borson, S. et al. (2013). Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimers & Dementia, 9, 151–159.Google Scholar
Boustani, M., Peterson, B., Hanson, L., Harris, R. and Lohr, K. N. (2003). Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive services task force. Annals of Internal Medicine, 138, 927–937.Google Scholar
Calabrese, P. and Kessler, J. (2000). Screening for cognitive impairment in dementia - the DemTect procedure. European Neuropsychopharmacology, 10, 369.CrossRefGoogle Scholar
Connolly, A., Gaehl, E., Martin, H., Morris, J. and Purandare, N. (2011). Underdiagnosis of dementia in primary care: variations in the observed prevalence and comparisons to the expected prevalence. Aging & Mental Health, 15, 978–984.CrossRefGoogle Scholar
Desgagne, A., Castilloux, A. M., Angers, J. F. and LeLorier, J. (1998). The use of the bootstrap statistical method for the pharmacoeconomic cost analysis of skewed data. Pharmacoeconomics, 13, 487–497.Google Scholar
Dreier, A., Thyrian, J. R. and Hoffmann, W. (2011). Dementia care manager in der ambulanten demenzversorgung: entwicklung einer innovativen qualifizierung für pflegefachkräfte. Pflege & Gesellschaft, 16, 53–64.Google Scholar
Eisele, M. et al. (2010). Utilization patterns of ambulatory medical care before and after the diagnosis of dementia in Germany - results of a case-control study. Dementia and Geriatric Cognitive Disorders, 29, 475–483.CrossRefGoogle ScholarPubMed
Eichler, T. et al. (2013). Dementia care management: going new ways in ambulant dementia care within a GP-based randomized controlled intervention trial. International Psychogeriatrics, 26, 247–256.Google Scholar
Eichler, T. et al. (2014). Rates of formal diagnosis in people screened positive for dementia in primary care: results of the DelpHi-trial. Journal of Alzheimers Disease, 42, 451–458.CrossRefGoogle ScholarPubMed
Federal Statistical Office (2013a). Grunddaten der Krankenhäuser 2012. Wiesbaden: Statistisches Bundesamt.Google Scholar
Federal Statistical Office (2013b). Kostennachweis der Krankenhäuser 2012. Wiesbaden: Statistisches Bundesamt.Google Scholar
Federal Statistical Office (2013c). Pflegestatistik 2011- Pflege im Rahmen der Pflegeversicherung Deutschlandergebnisse. Wiesbaden: Statistisches Bundesamt.Google Scholar
Fendrich, K. and Hoffmann, W. (2007). More than just aging societies: the demographic change has an impact on actual numbers of patients. Journal of Public Health, 15, 345–351.Google Scholar
Gauggel, S. and Birkner, B. (1999). Validity and reliability of a German version of the Geriatric Depression Scale (GDS). Zeitschrift fur Klinische Psychologie - Forschung und Praxis, 28, 18–27.CrossRefGoogle Scholar
German Association for Psychiatry, Psychotherapy and Psychosomatics & German Association for Neurology (DGN) (2009). S-3 Leitlinie “Demenzen”. Available at: http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/kurzversion-leitlinien/s3-leitlinie-demenz-lf.pdf; last accessed 1 November 2014.Google Scholar
Handels, R. L. H., Wolfs, C. A. G., Aalten, P., Verhey, F. R. J. and Severens, J. L. (2013). Determinants of care costs of patients with dementia or cognitive impairment. Alzheimer Disease & Associated Disorders, 27, 30–36.Google Scholar
Hindmarch, I., Lehfeld, H., E. J. P. and Erzigkeit, H. (1998). The bayer activities of daily living scale (B-ADL). Dementia and Geriatric Cognitive Disorders, 9, 20–26.Google Scholar
Hoffmann, F., Van den Bussche, H., Glaeske, G. and Kaduszkiewicz, H. (2010). Eight-year prescription trends of memantine and cholinesterase inhibitors among persons 65 years and older in Germany. International Clinical Psychopharmacology, 25, 29–36.CrossRefGoogle ScholarPubMed
Kaduszkiewicz, H., Wiese, B., Steinmann, S., Schon, G., Hoffmann, F. and Van den, B. H. (2014). Diagnosing and diagnosis coding of dementias in claims data from German statutory health insurance. Psychiatrische Praxis, 41, 319–323.Google ScholarPubMed
Kessler, J., Markowitsch, H. J. and Denzler, P. (1990). Mini-Mental-Status-Test (MMST) [German Version]. Göttingen, Beltz Test GmbH.Google Scholar
Krauth, C., Hessel, F., Hansmeier, T., Wasem, J., Seitz, R. and Schweikert, B. (2005). Empirical standard costs for health economic evaluation in Germany – a proposal by the working group methods in health economic evaluation. Gesundheitswesen, 67, 736–746.CrossRefGoogle Scholar
Leicht, H. et al. (2011). Net costs of dementia by disease stage. Acta Psychiatrica Scandinavica, 124, 384–395.Google Scholar
Michalowsky, B. et al. (2014). Medication cost of persons with dementia in primary care in germany. Journal of Alzheimers Disease, 42, 949–958.CrossRefGoogle ScholarPubMed
Prince, M., Bryce, R. and Ferri, C. (2011). World Alzheimer Report 2011 - The benefits of early diagnosis and intervention. Alzheimer's Disease International (ADI), London.Google Scholar
Sano, M., Wilcock, G. K., Van, B. B. and Kavanagh, S. (2003). The effects of galantamine treatment on caregiver time in Alzheimer's disease. International Journal of Geriatric Psychiatry, 18, 942–950.Google Scholar
Schwarzkopf, L. et al. (2011). Costs of care for dementia patients in community setting: an analysis for mild and moderate disease stage. Value in Health, 14, 827–835.Google Scholar
Scientific Institute of the AOK (2013). GKV-Arzneimittelindex. Available at: http://www.wido.de/gkvarzneimittelind.html; last accessed 1 November 2014.Google Scholar
Thyrian, J. R. et al. (2012). Life- and person-centred help in Mecklenburg-western pomerania, Germany (DelpHi): study protocol for a randomised controlled trial. Trials, 13, 56.Google Scholar
Vergütungslisten/Vergütungsvereinbarungen der Kassenverbände (2014). Heilmittel-Einzelpreise in EURO nach Kassenart – Stand Mai 2014. Available at: http://www.kvwl.de/arzt/verordnung/hhm/heilmittel/heilmittelpreise.pdf; last accessed 1 November 2014.Google Scholar
Wimo, A., Jonsson, L., Bond, J., Prince, M. and Winblad, B. (2013). The worldwide economic impact of dementia 2010. Alzheimers Dement, 9, 1–11.Google Scholar
Wimo, A., Jonsson, L. and Winblad, B. (2006). An estimate of the worldwide prevalence and direct costs of dementia in 2003. Dementia and Geriatric Cognitive Disorders, 21, 175–181.Google Scholar
Wimo, A., Winblad, B., Stoffler, A., Wirth, Y. and Mobius, H. J. (2003). Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer's disease. Pharmacoeconomics, 21, 327–340.CrossRefGoogle ScholarPubMed
World Health Organization and Alzheimer's Disease International (2012). Dementia: a public health priority. Available at: http://apps.who.int/iris/bitstream/10665/75263/1/9789241564458_eng.pdf?ua=1; last accessed 1 November 2014.Google Scholar
Supplementary material: File

Michalowsky supplementary material S1

Supplementary Table

Download Michalowsky supplementary material S1(File)
File 22.6 KB
Supplementary material: File

Michalowsky supplementary material S2

Supplementary Table

Download Michalowsky supplementary material S2(File)
File 23 KB