Hans-Helmut König1, Hanna Leicht2, Christian Brettschneider2, Cadja Bachmann3, Horst Bickel4, Angela Fuchs5, Frank Jessen6, Mirjam Köhler3, Melanie Luppa7, Edelgard Mösch4, Michael Pentzek5, Jochen Werle8, Siegfried Weyerer8, Birgitt Wiese9, Martin Scherer3, Wolfgang Maier6, Steffi G Riedel-Heller7. 1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: h.koenig@uke.de. 2. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Psychiatry, Technical University of Munich, Munich, Germany. 5. Department of General Practice, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany. 6. Department of Psychiatry, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany. 7. Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany. 8. Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany. 9. Institute of Biometrics, Hannover Medical School, Hannover, Germany.
Abstract
OBJECTIVE: To compare the costs of care for community-dwelling dementia patients with the costs of care for dementia patients living in nursing homes from the societal perspective. DESIGN: Cross-sectional bottom-up cost of illness study nested within the multicenter German AgeCoDe-cohort. SETTING: Community and nursing homes. PARTICIPANTS: One hundred twenty-eight community-dwelling dementia patients and 48 dementia patients living in nursing homes. INTERVENTION: None. MEASUREMENTS: Utilization and costs of medical care and long term care, including formal and informal social and nursing care based on proxy interviews. Informal care was valued using the replacement cost method. RESULTS: Unadjusted mean annual total costs including informal care were €29,930 ($43,997) for community-dwelling patients and €33,482 ($49,218) for patients living in nursing homes. However, multiple regression analysis controlling for age, sex, deficits in basic and instrumental activities of daily living and comorbidity showed that living in the community significantly increased total costs by €11,344 ($16,676; P < .01) compared with living in a nursing home, mainly due to higher costs of informal care (+€20,585; +$30,260; P < .001). CONCLUSION: From the societal perspective care for dementia patients living in the community tends to cost more than care in nursing homes when functional impairment is controlled for.
OBJECTIVE: To compare the costs of care for community-dwelling dementiapatients with the costs of care for dementiapatients living in nursing homes from the societal perspective. DESIGN: Cross-sectional bottom-up cost of illness study nested within the multicenter German AgeCoDe-cohort. SETTING: Community and nursing homes. PARTICIPANTS: One hundred twenty-eight community-dwelling dementiapatients and 48 dementiapatients living in nursing homes. INTERVENTION: None. MEASUREMENTS: Utilization and costs of medical care and long term care, including formal and informal social and nursing care based on proxy interviews. Informal care was valued using the replacement cost method. RESULTS: Unadjusted mean annual total costs including informal care were €29,930 ($43,997) for community-dwelling patients and €33,482 ($49,218) for patients living in nursing homes. However, multiple regression analysis controlling for age, sex, deficits in basic and instrumental activities of daily living and comorbidity showed that living in the community significantly increased total costs by €11,344 ($16,676; P < .01) compared with living in a nursing home, mainly due to higher costs of informal care (+€20,585; +$30,260; P < .001). CONCLUSION: From the societal perspective care for dementiapatients living in the community tends to cost more than care in nursing homes when functional impairment is controlled for.
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