- Email: [email protected]
COST OF ILLNESS ESTIMATES FOR DEMENTIA IN DENMARK: A REVIEW
Poster Presentations: P2 disease progression was modeled using equations derived directly from trial data. Changes in antipsychotic medications use upon initiation of AD treatment and following treatment discontinuation were incorporated using data from a published retrospective cohort study. Costs included drug acquisition and monitoring costs, total medical costs and informal care costs associated with caregiver time. Costs were reported in 2013 US dollars. Costs and health outcomes were discounted at 3% per annum. Results: Over 3 years, combination therapy was less costly and more effective when compared with AChEI monotherapy. Combination therapy was associated with a discounted quality-adjusted life-year (QALY) gain of 0.13 per patient. Over 3 years, direct medical and societal discounted costs were reduced by $20,947 and $18,355 per patient, respectively. Reductions in costs were mostly attributable to reductions in the need for institutional care. With combination therapy, patient time at home was increased by an average of 3.99 months, with a reduction of time spent in the most severe stages of the AAIC 2014 Cost-Effectiveness of Memantine ER in the US disease of 2.29 months. One-way sensitivity analyses and probabilistic sensitivity analyses found that combination therapy was less costly and more effective than AChEI monotherapy in almost all scenarios. Conclusions: Memantine ER and AChEI for patients with moderate-to-severe AD is a cost-effective treatment compared to AChEI monotherapy in the US. P2-321
COST OF ILLNESS ESTIMATES FOR DEMENTIA IN DENMARK: A REVIEW
Kasper Jørgensen1, Gunhild Waldemar2, Jan Sørensen3, 1Danish Dementia Research Centre, Copenhagen, Denmark; 2Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; 3University of Southern Denmark, Odense, Denmark. Contact e-mail: kasper.joergensen@ rh.regionh.dk Background: Only few analyses of the health care costs associated with dementia are currently available for Denmark. The most comprehensive study from 1999 (Kronborg et al.) may no longer provide relevant descriptions of the health care resource use by patients with dementia due to changes in clinical practice and social development. Recently, four international reviews and meta-analyses have analysed the costs associated with dementia (Alzheimer’s Disease International (2013), the Eurocode collaboration (2011), the European Brain Council (2011) and the Health Economics Research Centre in Oxford (2011) respectively). The purpose of this study is to develop a comprehensive description of the current Danish social costs associated with dementia based on these reviews. Methods: Resource utilisations and cost assessments from high income countries and Western European countries were extrapolated to current Danish conditions by means of purchasing power parity and adjusted to the Danish price levels for 2013. The results are presented as: 1) estimated average cost per patient with dementia; and 2) social costs associated with dementia by combining the average cost estimates with recent Danish assessments of the dementia prevalence for 2013. Results: 1) Direct health care cost estimates per patient vary from EUR 10429 to 27383 and informal care cost estimates per case vary from EUR 11445 to 54185. The assessment of indirect costs was based on the only one of the four reviews that considered indirect costs. 2) With an assumed prevalence of 88617 patients with dementia for 2013 the national direct health care costs range from EUR 0.9 to 2.4 billion while informal care cost varies from EUR 1.0 to 4.8 billion. Conclusions: The recent international reviews have considerable variation in methodological approaches and therefore render large variation in the cost estimates for Denmark. More accurate estimates of the cost associated with dementia e.g. based on data from the Danish patients registries and identification based on hospital diagnoses are needed to provide a more accurate description of the social costs associated with dementia. P2-322
ALZHEIMER’S DISEASE SPECIAL COURTS
Jacobo Mintzer1, Ellen Steinberg2, 1Roper St. Francis Healthcare - CBRI, Charleston, South Carolina, United States; 2Charleston County Magistrate
P597
Court, Charleston, South Carolina, United States. Contact e-mail: jacobo. [email protected] Background: Thirty percent of citizens 65 or older and 71 percent of those over 80 have significant functional or cognitive impairment. Unfortunately, elder disability has consequences. Disabled elders are often targets of financial, psychological and physical abuse. Sometimes, disabled elders appear to be the abusers, when cognitive and mental disorders generate violent or abusive behavior often directed to the caregiver that devotes their time to the care of the disabled elder. Methods: Once the need for elder courts in South Carolina was established, a working group was developed consisting of a magistrate judge, an Alzheimer’s expert, and a government affairs specialist. The project was divided into four steps: 1) Develop an alliance with potential groups that will benefit from the creation of elder courts 2) Develop background materials 3) Develop the legal structure and functions of the court 4) Develop a community based support system of agencies and stakeholders that will provide support for the court functioning Results: An alliance was developed between the South Carolina chapter of the Alzheimer’s Association, the American Association of Retired Persons (AARP), the office of the South Carolina Chief Justice, the office of the Lieutenant Governor, a not-for-profit hospital, and political figures with interest in the elderly. A white paper was developed that describes the detailed process for the development of the courts. To that end, the Executive Director of the S.C. Institute of Medicine and Public Health, a local think tank concerned with judicial and health issues, was brought on to the team to develop a number of workshops and work-groups to include state senators and prominent jurists, to develop the scope of the court activities. A list was generated to include agencies willing to provide in-kind resources to assist the court in its functions to include the Area Agency on Aging, the Alzheimer’s Association, South Carolina Ombudsmen, and first responders. Conclusions: This poster provides a structure that will facilitate community based intervention developed in collaboration between the judiciary and community stakeholders.
P2-323
WORLD ALZHEIMER REPORT 2013 ON LONG-TERM CARE
Marc Wortmann1, 1Alzheimer’s Disease International, London, United Kingdom. Contact e-mail: [email protected] Background: Increased life expectancy is a worldwide trend. Age is the main risk factor for Alzheimer’s disease and other dementias. Many elderly need long-term care and for the World Alzheimer Report 2013 we did a study on dependency and need for care and all the care that is available during the various stages of dementia. Methods: Review of studies looking at dependency and long-term care systems around the world in terms of services, quality monitoring and financing. The review was done by the Global Observatory on Ageing and Dementia Care, London, in collaboration with Alzheimer’s Disease International. Results: The global profile of dependence is changing. Between 2010 and 2050, the total number of dependent people worldwide will nearly double from 349 million to 613 million, but the numbers of older people with needs for care will nearly treble from 101 to 277 million. Almost half of the older people who need personal care globally have dementia, while four-fifths of older people in nursing homes are people with dementia. This means that long-term care for older people is mainly dementia care. Despite the negative image of care in care homes and contrary to popular belief, we found that the quality of life in a care home is comparable with the quality of life of people with dementia at home. Financing of long-term care will be more challenging as a result of the demographic shift that occurs worldwide. Conclusions: The current and future costs of long-term care will be driven to a large extent by the course of the global dementia epidemic. Our success in designing and implementing effective strategies for the prevention of dementia, and in identifying treatments that can alter the course of the disease will be important determinants of future health and social care costs. People with dementia need more personal care than others, more hours of care, and
COST OF ILLNESS ESTIMATES FOR DEMENTIA IN DENMARK: A REVIEW
Kasper Jørgensen1, Gunhild Waldemar2, Jan Sørensen3, 1Danish Dementia Research Centre, Copenhagen, Denmark; 2Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; 3University of Southern Denmark, Odense, Denmark. Contact e-mail: kasper.joergensen@ rh.regionh.dk Background: Only few analyses of the health care costs associated with dementia are currently available for Denmark. The most comprehensive study from 1999 (Kronborg et al.) may no longer provide relevant descriptions of the health care resource use by patients with dementia due to changes in clinical practice and social development. Recently, four international reviews and meta-analyses have analysed the costs associated with dementia (Alzheimer’s Disease International (2013), the Eurocode collaboration (2011), the European Brain Council (2011) and the Health Economics Research Centre in Oxford (2011) respectively). The purpose of this study is to develop a comprehensive description of the current Danish social costs associated with dementia based on these reviews. Methods: Resource utilisations and cost assessments from high income countries and Western European countries were extrapolated to current Danish conditions by means of purchasing power parity and adjusted to the Danish price levels for 2013. The results are presented as: 1) estimated average cost per patient with dementia; and 2) social costs associated with dementia by combining the average cost estimates with recent Danish assessments of the dementia prevalence for 2013. Results: 1) Direct health care cost estimates per patient vary from EUR 10429 to 27383 and informal care cost estimates per case vary from EUR 11445 to 54185. The assessment of indirect costs was based on the only one of the four reviews that considered indirect costs. 2) With an assumed prevalence of 88617 patients with dementia for 2013 the national direct health care costs range from EUR 0.9 to 2.4 billion while informal care cost varies from EUR 1.0 to 4.8 billion. Conclusions: The recent international reviews have considerable variation in methodological approaches and therefore render large variation in the cost estimates for Denmark. More accurate estimates of the cost associated with dementia e.g. based on data from the Danish patients registries and identification based on hospital diagnoses are needed to provide a more accurate description of the social costs associated with dementia. P2-322
ALZHEIMER’S DISEASE SPECIAL COURTS
Jacobo Mintzer1, Ellen Steinberg2, 1Roper St. Francis Healthcare - CBRI, Charleston, South Carolina, United States; 2Charleston County Magistrate
P597
Court, Charleston, South Carolina, United States. Contact e-mail: jacobo. [email protected] Background: Thirty percent of citizens 65 or older and 71 percent of those over 80 have significant functional or cognitive impairment. Unfortunately, elder disability has consequences. Disabled elders are often targets of financial, psychological and physical abuse. Sometimes, disabled elders appear to be the abusers, when cognitive and mental disorders generate violent or abusive behavior often directed to the caregiver that devotes their time to the care of the disabled elder. Methods: Once the need for elder courts in South Carolina was established, a working group was developed consisting of a magistrate judge, an Alzheimer’s expert, and a government affairs specialist. The project was divided into four steps: 1) Develop an alliance with potential groups that will benefit from the creation of elder courts 2) Develop background materials 3) Develop the legal structure and functions of the court 4) Develop a community based support system of agencies and stakeholders that will provide support for the court functioning Results: An alliance was developed between the South Carolina chapter of the Alzheimer’s Association, the American Association of Retired Persons (AARP), the office of the South Carolina Chief Justice, the office of the Lieutenant Governor, a not-for-profit hospital, and political figures with interest in the elderly. A white paper was developed that describes the detailed process for the development of the courts. To that end, the Executive Director of the S.C. Institute of Medicine and Public Health, a local think tank concerned with judicial and health issues, was brought on to the team to develop a number of workshops and work-groups to include state senators and prominent jurists, to develop the scope of the court activities. A list was generated to include agencies willing to provide in-kind resources to assist the court in its functions to include the Area Agency on Aging, the Alzheimer’s Association, South Carolina Ombudsmen, and first responders. Conclusions: This poster provides a structure that will facilitate community based intervention developed in collaboration between the judiciary and community stakeholders.
P2-323
WORLD ALZHEIMER REPORT 2013 ON LONG-TERM CARE
Marc Wortmann1, 1Alzheimer’s Disease International, London, United Kingdom. Contact e-mail: [email protected] Background: Increased life expectancy is a worldwide trend. Age is the main risk factor for Alzheimer’s disease and other dementias. Many elderly need long-term care and for the World Alzheimer Report 2013 we did a study on dependency and need for care and all the care that is available during the various stages of dementia. Methods: Review of studies looking at dependency and long-term care systems around the world in terms of services, quality monitoring and financing. The review was done by the Global Observatory on Ageing and Dementia Care, London, in collaboration with Alzheimer’s Disease International. Results: The global profile of dependence is changing. Between 2010 and 2050, the total number of dependent people worldwide will nearly double from 349 million to 613 million, but the numbers of older people with needs for care will nearly treble from 101 to 277 million. Almost half of the older people who need personal care globally have dementia, while four-fifths of older people in nursing homes are people with dementia. This means that long-term care for older people is mainly dementia care. Despite the negative image of care in care homes and contrary to popular belief, we found that the quality of life in a care home is comparable with the quality of life of people with dementia at home. Financing of long-term care will be more challenging as a result of the demographic shift that occurs worldwide. Conclusions: The current and future costs of long-term care will be driven to a large extent by the course of the global dementia epidemic. Our success in designing and implementing effective strategies for the prevention of dementia, and in identifying treatments that can alter the course of the disease will be important determinants of future health and social care costs. People with dementia need more personal care than others, more hours of care, and