Dementia Tops Cancer and Heart Disease
in Cost
By Marilynn Marchione, Associated Press
Cancer and heart disease are bigger killers, but Alzheimer's
is the most expensive malady in the U.S., costing families and society $157
billion to $215 billion a year, according to a new study that looked at this in
unprecedented detail. The biggest cost of Alzheimer's and other types of
dementia isn't drugs or other medical treatments, but the care that's needed
just to get mentally impaired people through daily life, the nonprofit RAND
Corp.'s study found.
It also gives what experts say is the most reliable estimate
for how many Americans have dementia — around 4.1 million. That's less than the
widely cited 5.2 million estimate from the Alzheimer's Association, which comes
from a study that included people with less severe impairment.
"The bottom line here is the same: Dementia is among
the most costly diseases to society, and we need to address this if we're going
to come to terms with the cost to the Medicare and Medicaid system," said
Matthew Baumgart, senior director of public policy at the Alzheimer's
Association.
Dementia's direct costs, from medicines to nursing homes,
are $109 billion a year in 2010 dollars, the new RAND report found. That
compares to $102 billion for heart disease and $77 billion for cancer. Informal
care by family members and others pushes dementia's total even higher,
depending on how that care and lost wages are valued.
"The informal care costs are substantially higher for
dementia than for cancer or heart conditions," said Michael Hurd, a RAND
economist who led the study. It was sponsored by the government's National
Institute on Aging and will be published in Thursday's New England Journal of
Medicine.
Alzheimer's is the most common form of dementia and the
sixth leading cause of death in the United States. Dementia also can result
from a stroke or other diseases. It is rapidly growing in prevalence as the
population ages. Current treatments only temporarily ease symptoms and don't
slow the disease. Patients live four to eight years on average after an
Alzheimer's diagnosis, but some live 20 years. By age 80, about 75 percent of
people with Alzheimer's will be in a nursing home compared with only 4 percent
of the general population, the Alzheimer's group says.
"Most people have understood the enormous toll in terms
of human suffering and cost," but the new comparisons to heart disease and
cancer may surprise some, said Dr. Richard Hodes, director of the Institute on
Aging. "Alzheimer's disease has a burden that exceeds many of these other
illnesses," especially because of how long people live with it and need
care, he said.
For the new study, researchers started with about 11,000
people in a long-running government health survey of a nationally representative
sample of the population. They gave 856 of these people extensive tests to
determine how many had dementia, and projected that to the larger group to determine
a prevalence rate — nearly 15 percent of people over age 70.
Using Medicare and other records, they tallied the cost of
purchased care — nursing homes, medicines, other treatments — including
out-of-pocket expenses for dementia in 2010. Next, they subtracted spending for
other health conditions such as high blood pressure, diabetes or depression so
they could isolate the true cost of dementia alone.
"This is an important difference" from other
studies that could not determine how much health care cost was attributable
just to dementia, said Dr. Kenneth Langa, a University of Michigan researcher
who helped lead the work. Even with that adjustment, dementia topped heart
disease and cancer in cost, according to data on spending for those conditions
from the federal Agency for Healthcare Research and Quality.
Finally, researchers factored in unpaid care using two
different ways to estimate its value — foregone wages for caregivers and what
the care would have cost if bought from a provider such as a home health aide.
That gave a total annual cost of $41,000 to $56,000 per year for each dementia
case, depending on which valuation method was used.
"They did a very careful job," and the new
estimate that dementia affects about 4.1 million Americans seems the most solidly
based than any before, Hodes said. The government doesn't have an official estimate
but more recently has been saying "up to 5 million" cases, he said.
The most worrisome part of the report is the trend it
portends, with an aging population and fewer younger people "able to take
on the informal caregiving role," Hodes said. "The best hope to
change this apparent future is to find a way to intervene" and prevent
Alzheimer's or change its course once it develops, he said.
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