O-34:Predictors of high healthcare costs and cost trajectories in community-dwellers with Alzheimer's disease

摘要

Background: Alzheimer's disease (AD) is the most common form of dementia and a significant predictor of high healthcare costs. However, less is known on the variability of costs among persons with AD, and studies on the predictors of high healthcare costs among persons with AD have focussed on the period after AD diagnosis. Methods: We studied the cost determinants and trajectories among all community-dwellers with clinically verified AD, diagnosed during 2005-2011 in Finland (N = 70,531). Healthcare costs, and medication and hospitalisation costs for each six-month period from 5 years before to 3 years after AD diagnosis were calculated. Multivariate mixed-effect logistic regression were applied to model associations between predictors and high costs. Logistic latent class growth analyses were derived to identify potential subpopulations with similarities in cost trajectories instead of assuming that a single growth trajectory would adequately approximate the entire population. Results: Total healthcare costs were driven mainly by hospital costs. The definition of "high-cost person" was time-dependent as 63% belonged to the highest 10% at some timepoint during the study period and six distinct cost trajectories were identified. Strokes, cardiovascular diseases and mental and behavioural disorders were most strongly associated with high costs. Antidementia medication use was associated with lower costs. Conclusions: Our results complement previous data on comorbidities in longitudinal perspective as predictors of high costs. Our findings show that persons with AD had large individual fluctuation in healthcare costs over time and the definition of high-cost AD patient varies depending on the stage of disease