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The economic impact of moderate stage Alzheimer's disease in Italy: evidence from the UP-TECH randomized trial

  • Carlos Chiatti (a1), Gianluca Furneri (a1), Joseph M. Rimland (a1), Federica Demma (a1), Franco Bonfranceschi (a1), Laura Cassetta (a1), Filippo Masera (a2), Antonio Cherubini (a1), Andrea Corsonello (a1), Fabrizia Lattanzio (a1) and on behalf of the UP-TECH research group...

Abstract

Background:

There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families.

Methods:

This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community.

Results:

The societal burden of AD, composed of public, patient, and informal care costs, was about €20,000/yr. Out of this, the cost borne by the public sector was €4,534/yr. The main driver of public cost was the national cash-for-care allowance (€2,324/yr), followed by drug prescriptions (€1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at €13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure.

Conclusion:

The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org (Trial Registration number: NCT01700556).

Copyright

Corresponding author

Correspondence should be addressed to: Joseph M. Rimland, Italian National Research Center on Aging (INRCA), Ancona, Italy. Phone: +39-071-8004787; Fax: +39-071-35941. Email: j.rimland@inrca.it.

References

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Albert, M. S. et al. (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the national institute on aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7, 270279.
Barberger-Gateau, P., Commenges, D., Gagnon, M., Letenneur, L., Sauvel, C. and Dartigues, J. F. (1992). Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers. Journal of the American Geriatrics Society, 40, 11291134.
Belle, S. H. et al. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial. Annals of Internal Medicine, 145, 727738.
Björkgren, M. A., Fries, B. E. and Shugarman, L. R. (2000). A Rug-III case-mix system for home care. Canadian Journal on Aging, 19, 106125.
Black, B. S., Johnston, D., Rabins, P. V., Morrison, A., Lyketsos, C. and Samus, Q. M. (2013). Unmet needs of community-residing persons with dementia and their informal caregivers: findings from the maximizing independence at home study. Journal of the American Geriatrics Society, 61, 20872095.
Boada, M. et al. (1999). Costs of health care resources of ambulatory-care patients diagnosed with Alzheimer's disease in Spain. Medicina Clinica, 113, 690695.
Cardano, M., Costa, G. and Demaria, M. (2004). Social mobility and health in the turin longitudinal study. Social Science & Medicine, 58, 15631574.
Cavallo, M. C. and Fattore, G. (1997). The economic and social burden of Alzheimer disease on families in the Lombardy region of Italy. Alzheimer Disease & Associated Disorders, 11, 184190.
Chiatti, C., Di Rosa, M., Melchiorre, M. G., Manzoli, L., Rimland, J. M. and Lamura, G. (2013a). Migrant care workers as protective factor against caregiver burden: results from a longitudinal analysis of the EUROFAMCARE study in Italy. Aging & Mental Health, 17, 609614.
Chiatti, C. et al. (2013b). The UP-TECH project, an intervention to support caregivers of Alzheimer's disease patients in Italy: study protocol for a randomized controlled trial. Trials, 14, 155.
Chiatti, C. et al. (2015). The UP-TECH project, an intervention to support caregivers of Alzheimer's disease patients in Italy: preliminary findings on recruitment and caregiving burden in the baseline population. Aging & Mental Health, 19, 517525.
Coon, D. W., Thompson, L., Steffen, A., Sorocco, K. and Gallagher-Thompson, D. (2003). Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. The Gerontologist, 43, 678689.
Costa, N. et al. (2012). Methodological considerations in cost of illness studies on Alzheimer disease. Health Economics Review, 2, 18.
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10S16.
De Lillo, A. and Schizzerotto, A. (1985). La Valutazione Sociale delle Occupazioni. Una Scala di Stratificazione Occupazionale per l'Italia Contemporanea. Bologna, Italia: Il Mulino.
Erikson, R. (1984). Social class of men, women and families. Sociology, 18, 500514.
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 21122117.
Folstein, M., Folstein, S. and Mchugh, P. (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Hirdes, J. et al. (2010). interRAI Contact Assessment (CA) Form and User's Manual, 9.2. Ann Arbor, MI: InterRAI.
Huisman, M., Kunst, A. E. and Mackenbach, J. P. (2003). Socioeconomic inequalities in morbidity among the elderly: a European overview. Social Science and Medicine, 57, 861873.
Hurd, M. D., Martorell, P., Delavande, A., Mullen, K. J. and Langa, K. M. (2013). Monetary costs of dementia in the United States. The New England Journal of Medicine, 368, 13261334.
Hux, M. J., O’Brien, B. J., Iskedjian, M., Goeree, R., Gagnon, M. and Gauthier, S. (1998). Relation between severity of Alzheimer's disease and costs of caring. Canadian Medical Association Journal, 159, 457465.
Jonsson, L. and Wimo, A. (2009). The cost of dementia in Europe: a review of the evidence, and methodological considerations. Pharmacoeconomics, 27, 391403.
Jorm, A. F. and Jolley, D. (1998). The incidence of dementia: a meta-analysis. Neurology, 51, 728733.
Knapp, M., Iemmi, V. and Romeo, R. (2013). Dementia care costs and outcomes: a systematic review. International Journal of Geriatric Psychiatry, 28, 551561.
Konig, H. H. et al. (2014). The costs of dementia from the societal perspective: is care provided in the community really cheaper than nursing home care? Journal of the American Medical Directors Association, 15, 117126.
Leicht, H. et al. (2013). Predictors of costs in dementia in a longitudinal perspective. PLoS One, 8, e70018.
Leon, J., Cheng, C. K. and Neumann, P. J. (1998). Alzheimer's disease care: costs and potential savings. Health Affairs, 17, 206216.
Lindholm, C., Gustavsson, A., Jonsson, L. and Wimo, A. (2013). Costs explained by function rather than diagnosis–results from the SNAC Nordanstig elderly cohort in Sweden. International Journal of Geriatric Psychiatry, 28, 454462.
Luppa, M., Heinrich, S., Angermeyer, M. C., Konig, H. H. and Riedel-Heller, S. G. (2008). Healthcare costs associated with recognized and unrecognized depression in old age. International Psychogeriatrics, 20, 12191229.
Marche (2010). DGR 1729 “Model convention of sheltered housing for older people” Marche Region Italy.
Marvardi, M. et al. (2005). The caregiver burden inventory in evaluating the burden of caregivers of elderly demented patients: results from a multicenter study. Aging Clinical and Experimental Research, 17, 4653.
Mcdaid, D. (2001). Estimating the costs of informal care for people with Alzheimer's disease: methodological and practical challenges. International Journal of Geriatric Psychiatry, 16, 400405.
Mcdowell, I. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, 3rd edn. Oxford, New York: Oxford University Press.
Mckhann, G. M. et al. (2011). The diagnosis of dementia due to Alzheimer's disease: recommendations from the national institute on aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7, 263269.
Morris, J. N., Fries, B. E. and Morris, S. A. (1999). Scaling ADLs within the MDS. The Journals of Gerontology, Series A: Biological Sciences & Medical Sciences, 54, M546M553.
Novak, M. and Guest, C. (1989). Application of a multidimensional caregiver burden inventory. The Gerontologist, 29, 798803.
Poss, J. W., Hirdes, J. P., Fries, B. E., Mckillop, I. and Chase, M. (2008). Validation of resource utilization groups version III for home care (RUG-III/HC): evidence from a Canadian home care jurisdiction. Medical Care, 46, 380387.
Prince, M. (2004). Care arrangements for people with dementia in developing countries. International Journal of Geriatric Psychiatry, 19, 170177.
Reisberg, B., Auer, S. R. and Monteiro, I. M. (1996). Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. International Psychogeriatrics, 8 (Suppl. 3), 301308.
Schneider, J., Murray, J., Banerjee, S. and Mann, A. (1999). EUROCARE: a cross-national study of co-resident spouse carers for people with Alzheimer's disease: i–factors associated with carer burden. International Journal of Geriatric Psychiatry, 14, 651661.
Schwarzkopf, L. et al. (2012). Excess costs of dementia disorders and the role of age and gender—an analysis of German health and long-term care insurance claims data. BMC Health Services Research, 12, 165.
Shutes, I. and Chiatti, C. (2012). Migrant workers and emerging care markets in italy and UK. Journal of European Social Policy, 22, 392405.
Sink, K. M., Covinsky, K. E., Barnes, D. E., Newcomer, R. J. and Yaffe, K. (2006). Caregiver characteristics are associated with neuropsychiatric symptoms of dementia. Journal of the American Geriatrics Society, 54, 796803.
Thies, W. and Bleiler, L. (2011). Alzheimer's disease facts and figures. Alzheimer's & Dementia, 7, 208244.
Trabucchi, M. (1999). An economic perspective on Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 12, 2938.
Vasiliadis, H. M., Dionne, P. A., Preville, M., Gentil, L., Berbiche, D. and Latimer, E. (2013). The excess healthcare costs associated with depression and anxiety in elderly living in the community. The American Journal of Geriatric Psychiatry, 21, 536548.
Vitaliano, P., Zhang, J. and Scanlan, J. (2003). Is caregiving hazardous to one's physical health? A meta-analysis. Psychological Bulletin, 129, 946972.
WHO and ADI (2012). Dementia a Public Health Priority. Geneva: World Health Organization.
Wisniewski, S. R. et al. (2003). The resources for enhancing Alzheimer's caregiver health (reach): project design and baseline characteristics. Psychology and Aging, 18, 375384.

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