Alzheimer’s disease and related dementias (ADRD) affect about 5.7 million people in the US. Although most of those affected are covered by Medicare, many of the medical costs are not covered by insurance and must be borne by patients and their families. Total costs of care for ADRD have been estimated at more than $277 billion in the US in 2018.
A new study by Nilanjana Dwibedi, PhD and colleagues in the March 2018 issue of Medical Care estimates, using data from the 2012 Medicare Current Beneficiary Survey, that average annual unadjusted per-capita out-of-pocket (OOP) health care spending among people with ADRD is about 1.7 times higher than spending among Medicare beneficiaries without ADRD ($3,285 vs. $1,895). After adjusting for other factors, people with ADRD had 38% higher OOP costs than those without ADRD. The biggest differences in OOP costs between groups were in the areas of prescription drugs and home health costs.
Dwibedi and colleagues also explored the adjusted odds of a person with ADRD having a high OOP burden, which was defined as spending more than 10% of their income on OOP costs. Under this measure, 30% people with ADRD had a high burden, compared with 17% of people without ADRD.
Of note, Dwibedi and colleagues report substantially lower OOP costs among people with ADRD than did three recent studies by Kelley et al. (2015), Delavande et al. (2013), and Hurd et al. (2013). A brief summary of the different data sources and findings of all four studies is presented below.
Source: Created by the author for this post
From this high-level look the methods–specifically, the different data sources, years, inclusion/exclusion criteria, and whether dementia was imputed–it is clear that each study’s estimate is conditional on those methods. The conclusions of each study, with respect to how much it costs to care for a person with ADRD, must be interpreted in light of these methodological differences. As is often the case, the devil is in the detail.
Lisa M. Lines