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Economics of Dementia

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Economics of Dementia Julie Bynum, MD MPH December 7, 2010 * Why do generalist providers need to pay attention? Much published on the topic is in specialist journals. – PowerPoint PPT presentation

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Title: Economics of Dementia


1
Economics of Dementia
  • Julie Bynum, MD MPH
  • December 7, 2010

2
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3
Disease Specific Costs
  • Why Discuss them?

4
To Lobby for More Research Funding
Alzheimers Research Trust, 2010
5
Understand what needs to be done for better
outcomes in the future (or at least as good)
6
Canary in a coal mine
7
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8
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9
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10
Medicare Part A (Health Insurance) Trust Fund
Balance, 2001-2018Under High Cost, Low Cost,
and Intermediate Assumptions
Fund balance as of annual expenditures
Actual Projected
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.
11
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.

12
How are dementia costs different from other
diseases?
Alzheimers Research Trust, 2010
13
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
14
Distribution of costs is different in dementia
from other diseases.
15
Direct Costs
  • Who are the stakeholders?
  • Alt. (Who pays the bills?)

16
Local Care System
17
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18
Transitions
HOSPITAL
19
Expenditures Community vs. Institution in
Dementia
Bynum, Unadjusted Data MCBS 2004
20
Expenditures Compared to Other Diseases
Bynum, Unadjusted Data MCBS 2004
21
Difficulty Comparing Costs to Other Diseases
Bynum, Unadjusted Data MCBS 2004
  • Avg. 4 chronic conditions compared to 1
    without dementia.

Bynum JAGS 2004
22
Hospitalization
In Medicare approximately 50 of costs are for
hospital care.
Bynum JAGS 2004
23
Ask ourselves why?
  • Behavioral issues/psychiatric admissions
  • Inability to self manage chronic disease
  • Caregiver stress and burnout
  • Clinician uncertainties about diagnosis and
    management

24
Biopsychosocial Model of Health
Engel, 1977
25
Biopsychosocial Model of Costs for the Dementia
Patient
26
Consider how costs might be different in the
future
27
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
28
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

29
Acetyl Cholinesterase Inhibitors and
Controversies
30
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
31
What if we did non-medical care differently?
32
A Family Intervention to Delay Nursing Home
Placement of Patients with Alzheimers Disease A
Randomized Controlled TrialMittelman MS et al.
JAMA 19962761725.
  • Sample Referred, volunteer 206 spouse-caregivers
    of AD pts living at home with gt 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

33
Results Delay of Institutionalization 329 Days
Mittelman MS et al. JAMA 2761725-1731, 1996
34
Interventions Studied to Delay Nursing Home
Placement in People with Alzheimers Disease
Spouse-Caregiver Intervention
Drug Study Donepezil
No Effect on Nursing Home
Delay Placement by 329 Days
AD2000 Collaborative Group Lancet
20043632105-15.
Mittelman MS et al. JAMA 2761725-1731, 1996
35
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

36
Where Do People With Alzheimers Disease Live?
Source Alzheimers Association, 2004
37
Not everything that counts can be counted, and
not everything that can be counted
counts. Albert Einstein
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