Direct medical costs and source of cost differences across the spectrum of cognitive decline: A population-based study

Cynthia L. Leibson, Kirsten Hall Long, Jeanine E. Ransom, Rosebud O Roberts, Steven L. Hass, Amy M. Duhig, Carin Y. Smith, Jane A. Emerson, V. Shane Pankratz, Ronald Carl Petersen

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Abstract Background Objective cost estimates and source of cost differences are needed across the spectrum of cognition, including cognitively normal (CN), mild cognitive impairment (MCI), newly discovered dementia, and prevalent dementia. Methods Subjects were a subset of the Mayo Clinic Study of Aging stratified-random sampling of Olmsted County, MN, residents aged 70 to 89 years. A neurologist reviewed provider-linked medical records to identify prevalent dementia (review date = index). Remaining subjects were invited to participate in prospective clinical/neuropsychological assessments; participants were categorized as CN, MCI, or newly discovered dementia (assessment date = index). Costs for medical services/procedures 1-year pre-index (excluding indirect and long-term care costs) were estimated using line-item provider-linked administrative data. We estimated contributions of care-delivery site and comorbid conditions (including and excluding neuropsychiatric diagnoses) to between-category cost differences. Results Annual mean medical costs for CN, MCI, newly discovered dementia, and prevalent dementia were $6042, $6784, $9431, $11,678, respectively. Hospital inpatient costs contributed 70% of total costs for prevalent dementia and accounted for differences between CN and both prevalent and newly discovered dementia. Ambulatory costs accounted for differences between CN and MCI. Age-, sex-, education-adjusted differences reached significance for CN versus newly discovered and prevalent dementia and for MCI versus prevalent dementia. After considering all comorbid diagnoses, between-category differences were reduced (e.g., prevalent dementia minus MCI (from $4842 to $3575); newly discovered dementia minus CN (from $3578 to $711)). Following the exclusion of neuropsychiatric diagnoses from comorbidity adjustment, between-category differences tended to revert to greater differences. Conclusions Cost estimates did not differ significantly between CN and MCI. Substantial differences between MCI and prevalent dementia reflected high inpatient costs for dementia and appear partly related to co-occurring mental disorders. Such comparisons can help inform models aimed at identifying where, when, and for which individuals proposed interventions might be cost-effective.

Original languageEnglish (US)
Article number1965
Pages (from-to)917-932
Number of pages16
JournalAlzheimer's and Dementia
Volume11
Issue number8
DOIs
StatePublished - Aug 1 2015

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Dementia
Costs and Cost Analysis
Population
Cognitive Dysfunction
Inpatients
Social Adjustment
Sex Education
Hospital Costs
Long-Term Care
Mental Disorders
Cognition
Medical Records
Comorbidity

Keywords

  • Cognitive status
  • Cost
  • Dementia
  • Economics
  • Mild cognitive impairment
  • Utilization

ASJC Scopus subject areas

  • Clinical Neurology
  • Developmental Neuroscience
  • Cellular and Molecular Neuroscience
  • Psychiatry and Mental health
  • Geriatrics and Gerontology
  • Epidemiology
  • Health Policy

Cite this

Direct medical costs and source of cost differences across the spectrum of cognitive decline : A population-based study. / Leibson, Cynthia L.; Long, Kirsten Hall; Ransom, Jeanine E.; Roberts, Rosebud O; Hass, Steven L.; Duhig, Amy M.; Smith, Carin Y.; Emerson, Jane A.; Pankratz, V. Shane; Petersen, Ronald Carl.

In: Alzheimer's and Dementia, Vol. 11, No. 8, 1965, 01.08.2015, p. 917-932.

Research output: Contribution to journalArticle

Leibson, CL, Long, KH, Ransom, JE, Roberts, RO, Hass, SL, Duhig, AM, Smith, CY, Emerson, JA, Pankratz, VS & Petersen, RC 2015, 'Direct medical costs and source of cost differences across the spectrum of cognitive decline: A population-based study', Alzheimer's and Dementia, vol. 11, no. 8, 1965, pp. 917-932. https://doi.org/10.1016/j.jalz.2015.01.007
Leibson, Cynthia L. ; Long, Kirsten Hall ; Ransom, Jeanine E. ; Roberts, Rosebud O ; Hass, Steven L. ; Duhig, Amy M. ; Smith, Carin Y. ; Emerson, Jane A. ; Pankratz, V. Shane ; Petersen, Ronald Carl. / Direct medical costs and source of cost differences across the spectrum of cognitive decline : A population-based study. In: Alzheimer's and Dementia. 2015 ; Vol. 11, No. 8. pp. 917-932.
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N2 - Abstract Background Objective cost estimates and source of cost differences are needed across the spectrum of cognition, including cognitively normal (CN), mild cognitive impairment (MCI), newly discovered dementia, and prevalent dementia. Methods Subjects were a subset of the Mayo Clinic Study of Aging stratified-random sampling of Olmsted County, MN, residents aged 70 to 89 years. A neurologist reviewed provider-linked medical records to identify prevalent dementia (review date = index). Remaining subjects were invited to participate in prospective clinical/neuropsychological assessments; participants were categorized as CN, MCI, or newly discovered dementia (assessment date = index). Costs for medical services/procedures 1-year pre-index (excluding indirect and long-term care costs) were estimated using line-item provider-linked administrative data. We estimated contributions of care-delivery site and comorbid conditions (including and excluding neuropsychiatric diagnoses) to between-category cost differences. Results Annual mean medical costs for CN, MCI, newly discovered dementia, and prevalent dementia were $6042, $6784, $9431, $11,678, respectively. Hospital inpatient costs contributed 70% of total costs for prevalent dementia and accounted for differences between CN and both prevalent and newly discovered dementia. Ambulatory costs accounted for differences between CN and MCI. Age-, sex-, education-adjusted differences reached significance for CN versus newly discovered and prevalent dementia and for MCI versus prevalent dementia. After considering all comorbid diagnoses, between-category differences were reduced (e.g., prevalent dementia minus MCI (from $4842 to $3575); newly discovered dementia minus CN (from $3578 to $711)). Following the exclusion of neuropsychiatric diagnoses from comorbidity adjustment, between-category differences tended to revert to greater differences. Conclusions Cost estimates did not differ significantly between CN and MCI. Substantial differences between MCI and prevalent dementia reflected high inpatient costs for dementia and appear partly related to co-occurring mental disorders. Such comparisons can help inform models aimed at identifying where, when, and for which individuals proposed interventions might be cost-effective.

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