DESK REVIEWS | 07.01.10. What is the estimated cost of dementia?
DESK REVIEW | 07.01.10. What is the estimated cost of dementia?
There are some studies estimating the costs in Brazil. According to a cross-sectional study conducted with people living with dementia who attended an outpatient health care in a hospital in São Paulo, dementia direct and indirect costs were US$1,012.35, US$1,683.18, and US$1,372.30 per patient/month, respectively, for mild, moderate, and severe stages of dementia. These included the unpaid care costs, expenditures with transport, diapers, medication, use of emergency services, health insurance, hospital stay, etc. (Ferretti et al., 2018). Using a similar list of variables a study conducted with 93 caregivers being followed up by an outpatient clinic from the University of São Paulo Clinical Hospital, calculated a total monthly indirect care cost of US$1,122.40, US$1,508.90, and US$1,644.70, for mild, moderate, and severe stages of dementia, respectively (Ferretti et al., 2015). Another study revealed that R$90,108,885.14 (US$22,860,464.56) were spent with medication to Alzheimer’s disease by the Brazilian Unified Health System (SUS) between 2008 and 2013 (Costa et al., 2015). A more recent study conducted a cost-effectiveness analysis from the SUS perspective between donepezil and rivastigmine therapy for mild and moderate Alzheimer’s disease (AD). The study showed the annual cost (in Brazilian reais) for donepezil is 30,556.45 and for rivastigmine is 32,685.77. According to the current Brazilian clinical guidelines for AD, it is estimated that rivastigmine is less cost-effective (0.39 QUALY/32,685.77 Brazilian reais) than donepezil (da Silva et al., 2018).
Costa, R. D. F. da, Osorio-de-Castro, C. G. S., Silva, R. M. da, Maia, A. de A., Ramos, M. de C. B., & Caetano, R. (2015). Aquisição de medicamentos para a Doença de Alzheimer no Brasil: Uma análise no sistema federal de compras, 2008 a 2013. Ciência & Saúde Coletiva, 20(12), 3827–3838. https://doi.org/10.1590/1413-812320152012.11542015
da Silva, L. R., Vianna, C. M. M., Mosegui, G. B. G., Peregrino, A. A. F., Marinho, V., & Laks, J. (2018). Cost-effectiveness analysis of the treatment of mild and moderate Alzheimer’s disease in Brazil. Revista Brasileira de Psiquiatria, 41(3), 218–224. https://doi.org/10.1590/1516-4446-2017-0021
Ferretti, C., Nitrini, R., & Brucki, S. M. D. (2015). Indirect cost with dementia. A Brazilian study. Dementia & Neuropsychologia, 9(1), 42–50. https://doi.org/DOI:10.1590/S1980-57642015DN91000007
Ferretti, C., Sarti, F. M., Nitrini, R., Ferreira, F. F., & Brucki, S. M. D. (2018). An assessment of direct and indirect costs of dementia in Brazil. PLoS ONE, 13(3). https://doi.org/10.1371/journal.pone.0193209
Rao & Bharat (2013) conducted a study examining the cost of dementia care in India. The authors found that the annual household cost of dementia care ranged from INR 45,600 to INR 2,02,450 in urban areas and INR 20,300 and INR 66,025 in rural areas, with disease severity significantly influencing these costs. Medication, consultation, and hospitalisation were combined as medical costs and transportation, paid residential care or day care included as care, and remaining costs (informal caregiving and productivity loss of the person with dementia) were summarised under informal costs (Rao & Bharat, 2013). More than half of the total cost is attributed towards informal care, as per the study. Of the total costs, around two-third (60.3%) is spent on informal care, one-fourth (26.1%) on care related costs and the rest 13.6% is spent on medical costs (Rao & Bharat, 2013). The authors identified that with respect to disease severity, the greater the severity of the disease, the lower is the expenditure on medical costs and the greater is the expenditure on care related costs (Rao & Bharat, 2013).
Rao, G., & Bharath, S. (2013). Cost of dementia care in India: Delusion or reality? Indian Journal of Public Health, 57(2), 71. https://doi.org/10.4103/0019-557X.114986
ADI estimated that, in Indonesia, dementia costs US$1,777 million in 2015 (Alzheimer’s Disease International, 2019, p.4). There has been no official data on dementia cost according to the Indonesian government or research institutions. However, in 2015, the Executive Director of Alzheimer’s Indonesia DY Suharya estimated that the annual cost associated with dementia in Indonesia has increased from US$1.7 billion to US$2 billion. Unpublished data from Alzheimer Indonesia’s database of caregivers provides information on the approximate dementia-related cost of care that families incur on a monthly basis. Out of 193 respondents, 10.9% reported spending less than IDR 1 million, 38.3% between IDR 1-3 million, 26.4% between IDR 3-5 million, 18.7% between IDR 5-10 million, and 5.7% spend more than IDR 10 million per month (Alzheimer’s Indonesia database, October 2019, unpublished).
Alzheimer’s Disease International. (2019). World Alzheimer Report 2019: Attitudes to Dementia. Alzheimer’s Disease International.
Persons with dementia and their caregivers (often family members) experience a significant financial impact from the cost of social and health care and loss of income (World Health Organization (WHO), 2017). The cost of dementia in East Sub-Saharan Africa (which includes Kenya) increased by 267.4% from 2010 (US$ 0.4 billion) to 2015 (US$ 1.5 billion) with informal care costs estimated at 68.9%, direct medical cost at 20.8% and social care costs at 10.3% in 2015 (Prince et al., 2015). However, there is no study conducted in Kenya that has specifically evaluated the cost of dementia.
Prince, M., Wimo, A., Guerchet, M., Ali, G., Wu, Y., & Prina, M. (2015). World Alzheimer Report 2015: The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. Alzheimer’s Disease International. London. https://www.alzint.org/u/worldalzheimerreport2015summary.pdf
World Health Organization (WHO). (2017). Global action plan on the public health response to dementia 2017 – 2025. Geneva, Switzerland. https://apps.who.int/iris/bitstream/handle/10665/259615/9789241513487-eng.pdf?sequence=1
Using unit costs for other conditions and international estimates when local unit costs were not available, the ADI World Report 2016 (Prince et al., 2016) costing estimates of the pathway of dementia care in Mexico show that the costs of the task-shifted pathways are relatively low compared to overall healthcare spending, and puts the cost of the pathway in 2015, per diagnosed person in Mexico at $39 USD (or $3.90 per person with dementia). This likely reveals that specialised services are not available and that little is done and performed in primary care where resources are not available or are lower than in the secondary or tertiary care level. For example, this is reflected in the salaries for general practitioners compared to the specialists’ ones.
Prince, M., Comas-Herrera, A., Knapp, M., Guerchet, M., & Karagiannidou, M. (2016). World Alzheimer Report 2016 Improving healthcare for people living with dementia. Coverage, Quality and costs now and in the future. In Alzheimer’s Disease International (ADI).