Skip to main page content

• HOME
• Current
• Archive
• Feedback
• Subscribe
• Help

This Article Full Text Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by WOLSTENHOLME, J. L. Articles by HOPE, T. Search for Related Content PubMed PubMed Citation Articles by WOLSTENHOLME, J. L. Articles by HOPE, T.

Estimating the relationship between disease progression and cost of care in dementia

Health Economics Research Centre

PAUL FENN, B.Phil

Centre for Risk and Insurance Studies, Nottingham University Business School

ALASTAIR M. GRAY, PhD

Health Economics Research Centre, University of Oxford

JANET KEENE, DPhil and ROBIN JACOBY, FRCPsych

Department of Psychiatry, University of Oxford

TONY HOPE, FRCPsych

Department of Medical Ethics, University of Oxford

Correspondence: Jane L. Wolstenholme, Health Economic Research Centre, JHS, University of Oxford, Old Road, Headington, Oxford OX3 7LF

Declaration of interest The original study was funded by the Medical Research Council and the economic re-analysis by an unrestricted educational grant from Novartis.

Background Previous studies have shown a positive relationship between disease severity and cost.

Aims To explore the factors affecting time to institutionalisation and estimate the relationship between the costs of care and disease progression.

Method Retrospective analysis of a longitudinal data-set for a cohort of 100 patients diagnosed with Alzheimer's disease or vascular dementia.

Results Changes in both Mini-Mental State Examination (MMSE) and Barthel scores have independent and significant marginal effects on costs. Each one-point decline in the MMSE score is associated with a £56 increase in the four-monthly costs, whereas each one-point fall in the Barthel index is associated with a £586 increase in costs.

Conclusions It may be inappropriate for economic models of disease progression in dementia to be based solely on measures of cognitive change. MMSE and the Barthel index are independent significant predictors of time to institutionalisation and cost of care, but changes in the Barthel index are particularly important in predicting costs outside institutional care.

This article has been cited by other articles:

				C. A. G. Wolfs, C. D. Dirksen, A. Kessels, J. L. Severens, and F. R. J. Verhey Economic Evaluation of an Integrated Diagnostic Approach for Psychogeriatric Patients: Results of a Randomized Controlled Trial Arch Gen Psychiatry, March 1, 2009; 66(3): 313 - 323. [Abstract] [Full Text] [PDF]

				C. W. Zhu, N. Scarmeas, R. Torgan, M. Albert, J. Brandt, D. Blacker, M. Sano, and Y. Stern Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease Neurology, September 26, 2006; 67(6): 998 - 1005. [Abstract] [Full Text] [PDF]

				M. KNAPP, L. THORGRIMSEN, A. PATEL, A. SPECTOR, A. HALLAM, B. WOODS, and M. ORRELL Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis The British Journal of Psychiatry, June 1, 2006; 188(6): 574 - 580. [Abstract] [Full Text] [PDF]

				C. W. Zhu, N. Scarmeas, R. Torgan, M. Albert, J. Brandt, D. Blacker, M. Sano, and Y. Stern Clinical features associated with costs in early AD: Baseline data from the Predictors Study Neurology, April 11, 2006; 66(7): 1021 - 1028. [Abstract] [Full Text] [PDF]

				S. Dwyer Older People and Permanent Care: Whose Decision? Br. J. Soc. Work, October 1, 2005; 35(7): 1081 - 1092. [Abstract] [Full Text] [PDF]

				A. Bianchetti, F. Castelletti, and M. Trabucchi Costs of dementia The British Journal of Psychiatry, December 1, 2002; 181(6): 533 - 534. [Full Text]