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1.
Artigo em Alemão | MEDLINE | ID: mdl-31297549

RESUMO

BACKGROUND: Currently, there are 1.7 million people living with dementia (PwD) in Germany. This number is expected to double within the next decades. Estimates of the total societal economic burden of dementia are currently missing. OBJECTIVES: The aim was to estimate the current and future total cost and excess cost of dementia from a public payer and societal perspective. METHODS: Studies demonstrating the healthcare resource utilization of PwD in Germany were identified. Utilization data were aggregated using the sample size of different studies as a weight. Annual per capita costs of PwD and excess cost of dementia were calculated using standardized unit costs. Current and future costs were calculated based on published prevalence and population forecasts. RESULTS: PwD living at home had lower costs from a payer perspective compared to those who are institutionalized, but higher total societal cost due to the higher informal care time. The total cost for PwD from a payer perspective was 34 billion € in 2016. These costs could reach 90 billion € by 2060. The excess cost of dementia was 18 billion € in 2016 and is estimated to become 49 billion € by 2060 from a payer perspective, representing 54% of the total cost of PwD and up to 15% of the total costs associated with the elderly population. The total societal cost was 73 billion € in 2016 and is estimated to become 194 billion € by 2060. The excess cost of dementia was 54 billion € in 2016 and is estimated to become 145 billion € by 2060, representing 74% of the total societal cost of PwD and 36% of the total societal cost of the elderly. CONCLUSION: Dementia diseases represent a tremendous social and economic burden. Without a cure, supporting caregivers and implementing interventions that delay the functional and cognitive decline will be crucial to relieving the increasing costs.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Demência/economia , Demência/psicologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Cuidadores/estatística & dados numéricos , Alemanha , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Alocação de Recursos
2.
BMJ ; 365: l4223, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221622

RESUMO

The studyClare L, Kudlicka A, Oyebode J R, et al. Goal-oriented cognitive rehabilitation for early-stage Alzheimer's and related dementias: the GREAT RCT. Health Technol Assess 2019;23:1-242.The trial was funded by the NIHR Health Technology Assessment Programme (project number11/15/04).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000767/goal-setting-in-early-stage-dementia-can-improve-function.


Assuntos
Disfunção Cognitiva/economia , Disfunção Cognitiva/reabilitação , Demência/psicologia , Atividades Cotidianas , Disfunção Cognitiva/psicologia , Análise Custo-Benefício , Demência/economia , Demência/epidemiologia , Demência/reabilitação , Metas , Humanos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoeficácia , Avaliação da Tecnologia Biomédica , Resultado do Tratamento , Reino Unido
3.
BMC Health Serv Res ; 19(1): 313, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096989

RESUMO

BACKGROUND: Most studies that examine comorbidity and its impact on health service utilization focus on a single index-condition and are published in disease-specific journals, which limit opportunities to identify patterns across conditions/disciplines. These comparisons are further complicated by the impact of using different study designs, multimorbidity definitions and data sources. The aim of this paper is to share insights on multimorbidity and associated health services use and costs by reflecting on the common patterns across 3 parallel studies in distinct disease cohorts (diabetes, dementia, and stroke) that used the same study design and were conducted in the same health jurisdiction over the same time period. METHODS: We present findings that lend to broader Insights regarding multimorbidity based on the relationship between comorbidity and health service use and costs seen across three distinct disease cohorts. These cohorts were originally created using multiple linked administrative databases to identify community-dwelling residents of Ontario, Canada with one of diabetes, dementia, or stroke in 2008 and each was followed for health service use and associated costs. RESULTS: We identified 376,434 indviduals wtih diabetes, 95,399 wtih dementia, and 29,671 with stroke. Four broad insights were identified from considering the similarity in comorbidity, utilization and cost patterns across the three cohorts: 1) the most prevalent comorbidity types were hypertension and arthritis, which accounted for over 75% of comorbidity in each cohort; 2) overall utilization increased consistently with the number of comorbidities, with the vast majority of services attributed to comorbidity rather than the index conditions; 3) the biggest driver of costs for those with lower levels of comorbidity was community-based care, e.g., home care, GP visits, but at higher levels of comorbidity the driver was acute care services; 4) service-specific comorbidity and age patterns were consistent across the three cohorts. CONCLUSIONS: Despite the differences in population demographics and prevalence of the three index conditions, there are common patterns with respect to comorbidity, utilization, and costs. These common patterns may illustrate underlying needs of people with multimorbidity that are often obscured in literature that is still single disease-focused.


Assuntos
Demência/epidemiologia , Diabetes Mellitus/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Multimorbidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artrite/epidemiologia , Comorbidade , Demência/economia , Diabetes Mellitus/economia , Feminino , Serviços de Saúde/economia , Humanos , Hipertensão/epidemiologia , Masculino , Ontário/epidemiologia , Prevalência , Projetos de Pesquisa , Acidente Vascular Cerebral/economia
5.
Lancet Psychiatry ; 6(4): 293-304, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30872010

RESUMO

BACKGROUND: Many people with dementia living in care homes have distressing and costly agitation symptoms. Interventions should be efficacious, scalable, and feasible. METHODS: We did a parallel-group, cluster-randomised controlled trial in 20 care homes across England. Care homes were eligible if they had 17 residents or more with dementia, agreed to mandatory training for all eligible staff and the implementation of plans, and more than 60% of eligible staff agreed to participate. Staff were eligible if they worked during the day providing face-to-face care for residents with dementia. Residents were eligible if they had a known dementia diagnosis or scored positive on screening with the Noticeable Problems Checklist. A statistician independent of the study randomised care homes (1:1) to the Managing Agitation and Raising Quality of Life (MARQUE) intervention or treatment as usual (TAU) using computer-generated randomisation in blocks of two, stratified by type of home (residential or nursing). Care home staff were not masked to the intervention but were asked not to inform assessors. Residents with dementia, family carers, outcome assessors, statisticians, and health economists were masked to allocation until the data were analysed. MARQUE is an evidence-based manualised intervention, delivered by supervised graduate psychologists to staff in six interactive sessions. The primary outcome was agitation score at 8 months, measured using the Cohen-Mansfield Agitation Inventory (CMAI). Analysis of the primary outcome was done in the modified intention-to-treat population, which included all randomly assigned residents for whom CMAI data was available at 8 months. Mortality was assessed in all randomly assigned residents. This study is registered with the ISRCTN registry, number ISRCTN96745365. FINDINGS: Between June 14, 2016, and July 4, 2017, we randomised ten care homes (189 residents) to the MARQUE intervention and ten care homes (215 residents) to TAU. At 8 months, primary outcome data were available for 155 residents in the MARQUE group and 163 residents in the TAU group. At 8 months, no significant differences in mean CMAI scores were identified between the MARQUE and TAU groups (adjusted difference -0·40 [95% CI -3·89 to 3·09; p=0·8226]). In the intervention care homes, 84% of all eligible staff completed all sessions. The mean difference in cost between the MARQUE and TAU groups was £204 (-215 to 623; p=0·320) and mean difference in quality-adjusted life-years was 0·015 (95% CI -0·004 to 0·034; p=0·127). At 8 months, 27 (14%) of 189 residents in the MARQUE group and 41 (19%) of 215 residents in the TAU group had died. The prescription of antipsychotic drugs was not significantly different between the MARQUE group and the TAU group (odds ratio 0·66; 95% CI 0·26 to 1·69, p=0·3880). INTERPRETATION: The MARQUE intervention was not efficacious for agitation although feasible and cost-effective in terms of quality of life. Addressing agitation in care homes might require resourcing for delivery by professional staff of a more intensive intervention, implementing social and activity times, and a longer time to implement change. FUNDING: UK Economic and Social Research Council and the National Institute of Health Research.


Assuntos
Demência/terapia , Agitação Psicomotora/terapia , Qualidade de Vida , Instituições Residenciais , Idoso de 80 Anos ou mais , Antipsicóticos/uso terapêutico , Esgotamento Profissional , Cuidadores , Análise Custo-Benefício , Demência/economia , Demência/mortalidade , Medicina Baseada em Evidências , Família , Estudos de Viabilidade , Feminino , Seguimentos , Pessoal de Saúde/psicologia , Humanos , Masculino , Agitação Psicomotora/economia , Agitação Psicomotora/mortalidade , Anos de Vida Ajustados por Qualidade de Vida , Instituições Residenciais/economia , Método Simples-Cego , Falha de Tratamento
6.
Br J Hosp Med (Lond) ; 80(3): 162-166, 2019 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-30860910

RESUMO

The proactive elderly care team was introduced at Lancashire Teaching Hospitals NHS Foundation Trust in October 2012. This article describes how the team performed over 5 years (up to the end of December 2017). The proactive elderly care team had three broad aims related to all non-elective patients over the age of 75 years who either came to accident and emergency or were admitted into the hospital, irrespective of speciality: To screen all patients over the age of 75 years for delirium and dementia To identify patients over 75 years who were the most frail, and would benefit from a comprehensive geriatric assessment and targeted interventions To reduce length of stay for patients over the age of 75 years without any increase in their readmission rate. Following the introduction of the proactive elderly care team, length of stay and the readmission rate of patients who were seen by the service fell by about 50%. Almost £10 million has been saved and for every £1 invested in the proactive elderly care team service, over £12 was saved.


Assuntos
Delírio/diagnóstico , Demência/diagnóstico , Fragilidade/diagnóstico , Avaliação Geriátrica , Pessoal Administrativo , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Delírio/economia , Delírio/terapia , Demência/economia , Demência/terapia , Deambulação Precoce , Feminino , Fragilidade/economia , Geriatras , Custos Hospitalares/estatística & dados numéricos , Hospitalização , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Programas de Rastreamento , Enfermeiras Clínicas , Terapeutas Ocupacionais , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/organização & administração , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Fisioterapeutas , Polimedicação , Melhoria de Qualidade , Encaminhamento e Consulta , Reino Unido
7.
BMC Neurol ; 19(1): 33, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819136

RESUMO

BACKGROUND: Although patients with dementia frequently experience neuropsychological symptoms (NPS) such as agitation, which profoundly impacts patients, caregivers, and the healthcare system, few studies have evaluated the associated burden of agitation or agitation-related symptoms in dementia. METHODS: This retrospective analysis of claims data from the Truven Health MarketScan® database (2012-2015) compared clinical characteristics, treatment patterns, healthcare resource utilization, and costs among patients with dementia with behavioral disturbances (BD) versus patients with dementia without BD. Existing BD diagnosis codes 294.11 or 294.21 were used as a means to identify patients with agitation/agitation-related symptoms. RESULTS: From a starting sample of 6.4 million beneficiaries, 103,402 patients with dementia were identified, of whom 16,440 (16%) had BD during an average of 17 months of follow-up. Patients with BD had significantly more medical and psychiatric comorbidities and greater comedication use (i.e., antidementia drugs, antidepressants, and antipsychotics; all values, P < .0001) compared with patients without BD. A significantly greater number of hospitalizations, hospital days, outpatient hospital/clinic visits, number of skilled nursing visits, and number of patients with hospice visit were reported during follow-up in patients with BD compared with patients without BD (all values, P <  0.0001). Costs were also significantly higher among patients with BD versus those patients without BD ($42,284 vs. $32,640, respectively; P <  0.0001). CONCLUSIONS: Patients with dementia with BD had a higher prevalence of comorbidities, greater use of comedications, and greater healthcare utilization and costs than patients with dementia without BD.


Assuntos
Efeitos Psicossociais da Doença , Demência/economia , Demência/psicologia , Comportamento Problema , Idoso , Comorbidade , Bases de Dados Factuais , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Estudos Retrospectivos , Estados Unidos
8.
Medicine (Baltimore) ; 98(7): e14468, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762764

RESUMO

Reducing the need for advanced nursing care and medical expenses is an essential concern of dementia care. We investigated the impact of traditional Chinese medicine (TCM) on advanced nursing care and medical costs.We used Longitudinal Health Insurance Database to implement a cohort study of patients with dementia between 1997 and 2012 in Taiwan. Data from the onset of dementia to 1st advanced nursing care for the endotracheal tube, urinal indwelling catheterization, and nasogastric tube were assessed using Cox regression proportional hazards model, and independent t test was used to determine the difference of hospitalization costs and days. We also used ANOVA test to compare the hospital cost, hospital stay, and numbers according to different duration of TCM.We assessed 9438 new diagnosed patients with dementia without advanced nursing care were categorized into 2 groups: 4094 (43.4%) TCM users, and 5344 (56.6%) non-TCM users. In the TCM groups, 894 (21.8%) patients were declared as advanced nursing care, while 1683 (31.5%) patients were in non-TCM group. Cox proportional hazard regression indicated that using TCM may decrease the need for advanced nursing care (adjusted hazard ratio (aHR) = 0.61, 95% confidence interval [95% CI]: 0.56-0.66) compared to non-TCM. The TCM users have lower hospitalization costs and hospitalization time compared to non-TCM users.Integrating TCM healthcare into dementia care was found to be associated with a lower need for advanced nursing care, hospitalization costs, and admission time with more benefits from longer durations of TCM use.


Assuntos
Demência/terapia , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Medicina Tradicional Chinesa/métodos , Terapia por Acupuntura/economia , Terapia por Acupuntura/métodos , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Demência/economia , Medicamentos de Ervas Chinesas/economia , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem/estatística & dados numéricos , Modelos de Riscos Proporcionais , Características de Residência , Fatores Sexuais , Fatores Socioeconômicos , Taiwan
10.
Nihon Ronen Igakkai Zasshi ; 55(4): 663-667, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-30542033

RESUMO

Upon diagnosis of dementia, a 93-year-old woman was unable to manage her finances. Her nephew illegally spent her money, which was considered as financial abuse.The public office forcibly admitted her to our hospital as a legal measure. After five years, she attained the terminal stage owing to eating disorders.While the medical team was preparing for end-of-life care, the patient's guardian of adult had sent informed consent form to perpetrator who was accused of financial abuse because the guardian had no authority of decision-making.On learning about the whereabouts of his aunt, the perpetrator contacted the medical team which then attempted to resolve the conflict of opinions.However, obtaining the family's consent emerged into an exhaustive and stressful process for the staff.In the present system, wherein the guardians of adult have no authority over medical treatment policy, they should, at least, participate in the discussion of future opinions and cooperate with a constructive attitude.In contrast, the medical team should offer better information to the guardians of elderly patients to devise a proper treatment plan.


Assuntos
Demência/economia , Tutores Legais , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Doações , Humanos , Equipe de Assistência ao Paciente , Assistência Terminal
11.
Value Health ; 21(4): 471-481, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29680105

RESUMO

BACKGROUND: Several utility-based instruments have been applied in cost-utility analysis to assess health state values for people with dementia. Nevertheless, concerns and uncertainty regarding their performance for people with dementia have been raised. OBJECTIVES: To assess the performance of available utility-based instruments for people with dementia by comparing their psychometric properties and to explore factors that cause variations in the reported health state values generated from those instruments by conducting meta-regression analyses. METHODS: A literature search was conducted and psychometric properties were synthesized to demonstrate the overall performance of each instrument. When available, health state values and variables such as the type of instrument and cognitive impairment levels were extracted from each article. A meta-regression analysis was undertaken and available covariates were included in the models. RESULTS: A total of 64 studies providing preference-based values were identified and included. The EuroQol five-dimension questionnaire demonstrated the best combination of feasibility, reliability, and validity. Meta-regression analyses suggested that significant differences exist between instruments, type of respondents, and mode of administration and the variations in estimated utility values had influences on incremental quality-adjusted life-year calculation. CONCLUSIONS: This review finds that the EuroQol five-dimension questionnaire is the most valid utility-based instrument for people with dementia, but should be replaced by others under certain circumstances. Although no utility estimates were reported in the article, the meta-regression analyses that examined variations in utility estimates produced by different instruments impact on cost-utility analysis, potentially altering the decision-making process in some circumstances.


Assuntos
Demência/economia , Demência/terapia , Custos de Cuidados de Saúde , Indicadores Básicos de Saúde , Avaliação de Processos (Cuidados de Saúde)/economia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Demência/diagnóstico , Demência/psicologia , Nível de Saúde , Humanos , Saúde Mental , Modelos Econômicos , Valor Preditivo dos Testes , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
12.
Int J Clin Pharmacol Ther ; 56(7): 301-309, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29701170

RESUMO

BACKGROUND: Whilst there was no upturn in detection rate of persons with dementia (PwD) in German general practitioner (GP) practices before 2012, dementia diagnoses markedly increased in 2013 and 2014. OBJECTIVE: (1) Verify the increase of dementia diagnoses in GP practices and neurologist/psychiatrist (NP) practices; (2) examine the subsequent prescription of antidementia drugs. MATERIALS AND METHODS: We performed a retrospective, longitudinal analysis of 874 GP and 141 NP practices collecting clinical data about 220,213 patients who received a dementia diagnosis (ICD-10: G30, F01, F03) between 2011 and 2015. RESULTS: In GP practices, documented dementia diagnoses increased by 73% between 2012 and 2014 (mean 6.4 - 11.1 PwD/practice) and decreased by 26% in 2015 (8.3 PwD/practice). This trend was mostly due to the subgroup of nonspecific (+63%) and vascular dementia (+170%). The upturn has been accompanied by a downturn of the proportion of PwD receiving antidementia drugs (2012: 13.9% vs. 2014: 7.8%). Neither of these trends was found in NP practices. CONCLUSION: The upturn parallels the introduction of monetary incentives for both patients and GPs. It should be examined if these monetary incentives will also lead to an improvement in treatment and care of PwD in the long run.
.


Assuntos
Demência/diagnóstico , Demência/tratamento farmacológico , Serviços de Saúde para Idosos , Neurologia , Nootrópicos/uso terapêutico , Padrões de Prática Médica , Atenção Primária à Saúde , Psiquiatria , Especialização , Idoso , Idoso de 80 Anos ou mais , Demência/economia , Demência/psicologia , Custos de Medicamentos , Prescrições de Medicamentos , Feminino , Alemanha , Serviços de Saúde para Idosos/economia , Serviços de Saúde para Idosos/tendências , Humanos , Estudos Longitudinais , Masculino , Neurologia/economia , Neurologia/tendências , Nootrópicos/efeitos adversos , Nootrópicos/economia , Planos de Incentivos Médicos , Padrões de Prática Médica/economia , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/tendências , Psiquiatria/economia , Psiquiatria/tendências , Encaminhamento e Consulta , Estudos Retrospectivos , Especialização/economia , Especialização/tendências , Fatores de Tempo , Resultado do Tratamento
13.
PLoS One ; 13(3): e0193209, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29494693

RESUMO

BACKGROUND: To analyze costs associated with dementia based on a cross-sectional study in the Brazilian health system. METHODS: Direct and indirect costs were estimated by conducting comprehensive interviews on the use of resources in a sample of 156 patients with dementia treated at an outpatient memory clinic of a tertiary hospital. A regression model was used to determine the main determinants of costs associated with dementia. RESULTS: Global costs of dementia were US$1,012.35; US$1,683.18 and US$1,372.30 per patient/month for mild, moderate and severe stages, respectively. Indirect costs ranged from US$536.62 to US$545.17 according to severity. Dementia costs were influenced by medication, FAST score, and educational level of caregiver. DISCUSSION: The study represents an original contribution toward establishing direct and indirect costs of dementia in Brazil. Results indicate significant economic impacts, including projection of annual costs of US$16,548.24 per patient.


Assuntos
Efeitos Psicossociais da Doença , Demência/economia , Idoso , Idoso de 80 Anos ou mais , Brasil , Doenças Cardiovasculares/complicações , Cuidadores/economia , Demência/complicações , Demência/patologia , Complicações do Diabetes/patologia , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Centros de Atenção Terciária
14.
BMC Geriatr ; 18(1): 69, 2018 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-29523090

RESUMO

BACKGROUND: This systematic review aims to review the literature on trial-based economic evaluations of non-pharmacological interventions directly targeted at persons with dementia as well as persons with mild cognitive impairment and their respective caregivers. METHODS: A systematic literature research was conducted for the timeframe from 2010 to 2016 in the following databases: Centre for Reviews and Dissemination, EconLit, Embase, Cochrane Library, PsycINFO and PubMed. Study quality was assessed according to the Drummond criteria. RESULTS: In total sixteen publications were identified. Health economic evaluations indicated the cost-effectiveness of physical exercise interventions and occupational therapy. There was also evidence to suggest that psychological and behavioral therapies are cost-effective. Health economic studies investigating psychosocial interventions mainly targeted towards informal caregivers showed inconsistent results. CONCLUSIONS: Due to the increasing prevalence of dementia non-pharmacological interventions and their health economic impact are of increasing importance for health care decision-makers and HTA agencies.


Assuntos
Cuidadores/economia , Análise Custo-Benefício/normas , Demência/economia , Demência/terapia , Terapia Comportamental/economia , Terapia Comportamental/métodos , Terapia Comportamental/normas , Cuidadores/psicologia , Análise Custo-Benefício/métodos , Demência/psicologia , Humanos , Terapia Ocupacional/economia , Terapia Ocupacional/métodos , Terapia Ocupacional/normas
15.
PLoS One ; 13(2): e0193319, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29474407

RESUMO

BACKGROUND: Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established. METHOD: To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient's Diagnosis Related Group from hospital discharge data. RESULTS: For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001). DISCUSSION: Hospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective. CONCLUSIONS: Complications and dementia were found to cost more than other kinds of inpatient complexity.


Assuntos
Delírio/economia , Demência/economia , Tempo de Internação/economia , Pneumonia/economia , Lesão por Pressão/economia , Infecções Urinárias/economia , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/etiologia , Demência/diagnóstico , Demência/epidemiologia , Demência/etiologia , Feminino , Humanos , Doença Iatrogênica/economia , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Pneumonia/etiologia , Lesão por Pressão/diagnóstico , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Estudos Retrospectivos , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
16.
BMJ Open ; 8(1): e019060, 2018 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-29362261

RESUMO

INTRODUCTION: Dementia is the fastest growing major cause of disability globally with a mounting social and financial impact for patients and their families but also to health and social care systems. This review aims to systematically synthesise evidence on the utilisation of resources and costs incurred by patients and their caregivers and by health and social care services across the full spectrum of dementia, from its preceding preclinical stage to end of life. The main drivers of resources used and costs will also be identified. METHODS AND ANALYSIS: A systematic literature review was conducted in MEDLINE, EMBASE, CDSR, CENTRAL, DARE, EconLit, CEA Registry, TRIP, NHS EED, SCI, RePEc and OpenGrey between January 2000 and beginning of May 2017. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed with the Effective Public Health Practice Project quality assessment tool. The reporting of costing methodology will be assessed using the British Medical Journal checklist. A narrative synthesis of all studies will be presented for resources used and costs incurred, by level of disease severity when available. If feasible, the data will be synthesised using appropriate statistical techniques. ETHICS AND DISSEMINATION: Included articles will be reviewed for an ethics statement. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. They will also contribute to the work developed in the Real World Outcomes across the Alzheimer's disease spectrum for better care: multi-modal data access platform (ROADMAP). TRIAL REGISTRATION NUMBER: CRD42017071413.


Assuntos
Cuidadores/economia , Demência/economia , Recursos em Saúde/estatística & dados numéricos , Análise Custo-Benefício , Humanos , Projetos de Pesquisa , Medição de Risco , Revisão Sistemática como Assunto
17.
BMC Geriatr ; 18(1): 9, 2018 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-29325531

RESUMO

BACKGROUND: The potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care. METHODS: Participants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults. RESULTS: Of all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted ß = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care. CONCLUSIONS: The use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs.


Assuntos
Custos de Cuidados de Saúde , Prescrição Inadequada/economia , Lista de Medicamentos Potencialmente Inapropriados/economia , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Instituições Residenciais/economia , Idoso , Idoso de 80 Anos ou mais , Moradias Assistidas/economia , Moradias Assistidas/tendências , Austrália/epidemiologia , Estudos Transversais , Demência/tratamento farmacológico , Demência/economia , Demência/epidemiologia , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Prescrição Inadequada/tendências , Masculino , Lista de Medicamentos Potencialmente Inapropriados/tendências , Prevalência , Instituições Residenciais/tendências , Estudos Retrospectivos
18.
Dementia (London) ; 17(3): 266-278, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27013520

RESUMO

Objective Peer support for people with dementia and carers is routinely advocated in national strategies and policy as a post-diagnostic intervention. However there is limited evidence to demonstrate the value these groups offer. This study looked at three dementia peer support groups in South London to evaluate what outcomes they produce and how much social value they create in relation to the cost of investment. Methods A Social Return on Investment (SROI) analysis was undertaken, which involves collecting data on the inputs, outputs and outcomes of an intervention, which are put into a formula, the end result being a SROI ratio showing how much social value is created per £1 of investment. Results Findings showed the three groups created social value ranging from £1.17 to £5.18 for every pound (£) of investment, dependent on the design and structure of the group. Key outcomes for people with dementia were mental stimulation and a reduction in loneliness and isolation. Carers reported a reduction in stress and burden of care. Volunteers cited an increased knowledge of dementia. Conclusions This study has shown that peer groups for people with dementia produce a social value greater than the cost of investment which provides encouraging evidence for those looking to commission, invest, set up or evaluate peer support groups for people with dementia and carers. Beyond the SROI ratio, this study has shown these groups create beneficial outcomes not only for the group members but also more widely for their carers and the group volunteers.


Assuntos
Demência/economia , Demência/psicologia , Apoio Social , Cuidadores , Análise Custo-Benefício , Feminino , Humanos , Londres , Masculino , Avaliação de Resultados (Cuidados de Saúde) , Grupo Associado
19.
Eur J Health Econ ; 19(1): 87-102, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28160100

RESUMO

The objectives of this cross-sectional analysis were to determine healthcare resource utilization and cost for community-dwelling patients with dementia (PWD) from a payer's and societal perspective, and to analyze the associations between costs and sociodemographic and clinical variables. Analysis of healthcare costs from a payer's perspective was based on a sample of 425 PWD, analysis of healthcare costs from societal perspective on a subsample of 254 PWD and their informal caregivers. Frequency of healthcare resource utilization was assessed by means of questionnaires. Informal care and productivity losses were assessed by using the Resource Utilization in Dementia questionnaire (RUD). Costs were monetarized using standardized unit costs. To analyze the associations, multiple linear regression models were used. Total annual costs per PWD valued 7016€ from a payer's and 25,877€ from a societal perspective, meaning that societal cost is approximately three and a half times as much as payer's expenditures. Costs valuated 5456 € for medical treatments, 1559 € for formal care, 18,327€ for informal care. Productivity losses valued 1297€ for PWD caregivers. Informal care could vary substantially (-21%; +33%) concerning different valuation methods. Medical care costs decreased significantly with progression of dementia and with age. Costs of care double over the stages of dementia. Formal care costs were significantly higher for PWD living alone and informal care costs significantly lower for PWD with an employed caregiver. For all cost categories, deficits in daily living activities were major cost drivers.


Assuntos
Técnica Delfos , Demência/terapia , Custos de Cuidados de Saúde , Atenção Primária à Saúde/economia , Cuidadores , Efeitos Psicossociais da Doença , Estudos Transversais , Demência/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/estatística & dados numéricos
20.
Int J Geriatr Psychiatry ; 33(1): 5-13, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28004429

RESUMO

OBJECTIVE: Recent research indicates considerable heterogeneity in the provision of memory assessment services (MAS). However, little is known on the extent of variation in the costs of the services MAS provide. We investigated the costs of supporting patients with suspected dementia, including assessment and support over the following 6 months. METHODS: Clinic costs were estimated on the basis of an organisational survey reporting staff roll, grade and activities. Costs of primary health and social care were estimated from questionnaire data reported by carers of patients at baseline, 3 and 6 months after referral. RESULTS: Mean monthly staff costs at MAS were £73 000. Imaging at assessment costs an additional £3500 per month. Monthly clinic cost per new patient assessed varied from £320 to £5400 across clinics. Additional primary health and social care costs of £130-220 a month between baseline and 6 months were reported by carers. Costs of pharmacological and non-pharmacological treatments reported by carers were small. Informal care costs dwarfed health and social care costs when valued at a modest unit cost. The overall mean cost of supporting a patient for 6 months varied from £1600 to £2500 dependent on assumptions regarding the proportion of MAS intervention and review costs accrued at 6 months. CONCLUSIONS: There is considerable variation in the intensity and associated costs of services provided by MAS. Further research should ascertain to what extent such variation is associated with differences in patient outcomes. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência , Custos de Cuidados de Saúde , Serviços de Saúde Mental/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Disfunção Cognitiva/economia , Demência/diagnóstico , Demência/economia , Demência/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/economia , Apoio Social , Inquéritos e Questionários
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