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Published online before print August 16, 2006, doi:10.1212/01.wnl.0000230160.13272.1b)
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Received January 27, 2006
Accepted April 11, 2006

Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease

C. W. Zhu PhD*, N. Scarmeas MD, MSc, R. Torgan MPH, M. Albert PhD, J. Brandt PhD, D. Blacker MD, ScD, M. Sano PhD, and Y. Stern PhD

From the Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness (C.W.Z., M.S.), Targeted Research Enhancement Program, Bronx VA Medical Center, Bronx, NY; Brookdale Department of Geriatrics (C.W.Z.) and Department of Psychiatry (M.S.), Mount Sinai School of Medicine, New York, NY; Cognitive Neuroscience Division of the Taub Institute for Research in Alzheimer’s Disease and the Aging Brain (N.S., R.T., Y.S.), Gertrude H. Sergievsky Center and the Department of Neurology, Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences (M.A., J.B.), Johns Hopkins University, Baltimore, MD; and Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School, Boston, MA.


* To whom correspondence should be addressed. E-mail: carolyn.zhu{at}mssm.edu.

Abstract-- Objectives: To estimate long-term trajectories of direct cost of caring for patients with Alzheimer disease (AD) and examine the effects of patients’ characteristics on cost longitudinally. Methods: The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed up annually for up to 7 years in three university-based AD centers in the United States. Random effects models estimated the effects of patients’ clinical and sociodemographic characteristics on direct cost of care. Direct cost included cost associated with medical and nonmedical care. Clinical characteristics included cognitive status (measured by Mini-Mental State Examination), functional capacity (measured by Blessed Dementia Rating Scale [BDRS]), psychotic symptoms, behavioral problems, depressive symptoms, extrapyramidal signs, and comorbidities. The model also controlled for patients’ sex, age, and living arrangements. Results: Total direct cost increased from approximately $9,239 per patient per year at baseline, when all patients were at the early stages of the disease, to $19,925 by year 4. After controlling for other variables, a one-point increase in the BDRS score increased total direct cost by 7.7%. One more comorbid condition increased total direct cost by 14.3%. Total direct cost was 20.8% lower for patients living at home compared with those living in an institutional setting. Conclusions: Total direct cost of caring for patients with Alzheimer disease increased substantially over time. Much of the cost increases were explained by patients’ clinical and demographic variables. Comorbidities and functional capacity were associated with higher direct cost over time.




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