LIFE EXPECTANCY TOTAL COST AND NET COST OF DEMENTIA: RESULTS FROM A DEMENTIA MICROSIMULATION MODEL

摘要

We developed a comprehensive US dementia microsimulation model to estimate life expectancy, total cost, and the net cost of dementia. The model simulated an incident dementia patients’ disease progression using cognition, function, and behavior (clinical features). The trajectories of the clinical features were derived from regression analyses using data from the National Alzheimer’s Coordinating Center. The clinical features were used to predict transitions between place of residence (community or long-term care facility), insurance status (Medicare or Medicare-Medicaid), and resource utilization (informal caregiving, out-of-pocket expenditures, Medicaid long-term care facility expenditures, and Medicare expenditures). At any time, a person with dementia could die of dementia-related or other causes. Individual incident cases were simulated to estimate mean life expectancy and the total value of care. To determine the net cost of dementia, we compared expenditures for a simulated person with dementia against a simulated person who did not exhibit cognitive deficits, functional limitations, or behavioral symptoms. A sub-analysis evaluated outcomes by age of dementia onset (75 and 90). Costs were discounted by 3%. Mean life expectancy was 70 months (mean age of dementia onset was 83 years). Discounted total value of care was $378,682. Individuals who experienced the clinical features of dementia incurred $282,436 ($48,420 annually) more care than those who did not. Total and net cost decreased with older age of dementia onset. A 90-year-old incident case had a life expectancy of 48 months and received $248,968 worth of care ($196,280 net). There is value in delaying the time to dementia onset.