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Neurology 2002;59:573-578
© 2002 American Academy of Neurology

Primary care expenditures before the onset of Alzheimer’s disease

S. M. Albert, PhD MSc, S. Glied, PhD, H. Andrews, PhD, Y. Stern, PhD and R. Mayeux, MD MSc

From the Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain; Divisions of Sociomedical Sciences and Health Policy and Management, School of Public Health; and Departments of Neurology and Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY.

Address correspondence and reprint requests to Dr. Steven M. Albert, Gertrude H. Sergievsky Center, P&S Box 16, PH-19, Columbia University, 630 W. 168 St., New York, NY 10032; e-mail: sma10{at}columbia.edu

Objective: To investigate primary care expenditures in the period before diagnosis of AD.

Methods: In a population-based sample of Medicare enrollees in New York City, person-level 1996 Medicare claims, summed over primary care encounters, were examined for people who developed AD in 1997 to 1998 and those who did not.

Results: People who developed AD were more likely to use Medicare outpatient and ambulatory care 1 to 2 years before diagnosis. Compared with respondents who did not develop AD, the excess cost for men was $1,167 (85% higher) and for women $239 (26% higher). Among elderly people >=75 years in the United States, the prodromal period of AD was associated with an excess Medicare-based primary care cost of $128.5 to $194.7 million.

Conclusion: In addition to huge costs associated with AD after diagnosis, prediagnosis costs are an unrecognized source of expenditures related to the disease.




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