@article{a4e2d456be384828a7759952ed8b8dad,
title = "Medical and nursing home costs: From cognitively unimpaired through dementia",
abstract = "Introduction: Efforts to model the cost-effectiveness of managing/modifying cognitive impairment lack reliable, objective, baseline medical, and nursing-home (NH) costs. Methods: A stratified-random sample of Olmsted County, MN, residents ages 70–89 years (N = 3545), well-characterized as cognitively unimpaired, mild cognitive impairment (MCI), or dementia, were followed forward ≤1 year in provider-linked billing data and the Centers for Medicare & Medicaid Services NH assessments. Direct medical/nursing home/medical + NH costs were estimated. Costs were stratified by vital status and NH-use intensity (NH days/follow-up days [0%, 1% to 24%, 25% to 99%, and 100%]). Between-category mean-annual cost differences were adjusted for patient characteristics and follow-up days. Results: Costs/follow-up day distributions differed significantly across cognitive categories. Mean costs/follow-up days were 2.5 to 18 times higher for decedents versus survivors. Among all persons with MCI, <9% with any NH use accounted for 18% of all total annual medical + NH costs. Adjusted-between-category comparisons revealed significantly higher medical and medical + NH costs for MCI versus cognitively unimpaired. Discussion: Cost-effectiveness for managing/modifying both MCI and dementia should consider end-of-life costs and NH-use intensity. Results can help inform cost-effectiveness models, predict future-care needs, and aid decision-making by individuals/providers/payers/policymakers.",
keywords = "cognitive status, cost, dementia, economics, mild cognitive impairment, nursing home",
author = "Long, {Kirsten Hall} and Carin Smith and Ronald Petersen and Jane Emerson and Jeanine Ransom and Mielke, {Michelle M.} and Steven Hass and Cynthia Leibson",
note = "Funding Information: The authors wish to acknowledge Dr. Rosebud Roberts for sharing her expertise, experience, and knowledge gained as part of her extensive involvement with and contributions to the Mayo Clinic Study of Aging (MCSA). We are appreciative of the guidance provided by Dr. Sue Visscher and members of the Rochester Epidemiology Project Cost and Utilization Committee. We also wish to thank the MCSA study participants for their generous contributions of time and information. As corresponding author I affirm that I have listed everyone who contributed significantly to the work and, with the exception of study participants, have obtained written consent from all contributors who are not authors and are named in the Acknowledgments section. This work was supported by AbbVie, Department of Health Economics and Outcomes Research, and the Mayo Clinic Study of Aging (National Institutes of Health [NIH] grant number U01 AG006786). Some study data were obtained from the Rochester Epidemiology Project, which is supported by the National Institute on Aging (NIH grant number R01 AG034676). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. In support of the manuscript, the NIH had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. AbbVie was involved with the initial study design; AbbVie had no role in the collection, analysis, or interpretation of data or in the preparation, review, or approval of the manuscript. Funding Information: The authors wish to acknowledge Dr. Rosebud Roberts for sharing her expertise, experience, and knowledge gained as part of her extensive involvement with and contributions to the Mayo Clinic Study of Aging (MCSA). We are appreciative of the guidance provided by Dr. Sue Visscher and members of the Rochester Epidemiology Project Cost and Utilization Committee. We also wish to thank the MCSA study participants for their generous contributions of time and information. As corresponding author I affirm that I have listed everyone who contributed significantly to the work and, with the exception of study participants, have obtained written consent from all contributors who are not authors and are named in the Acknowledgments section. This work was supported by Abbott, Department of Health Economics and Outcomes Research, and the Mayo Clinic Study of Aging (National Institutes of Health [NIH] grant number U01 AG006786). Some study data were obtained from the Rochester Epidemiology Project, which is supported by the National Institute on Aging (NIH grant number R01 AG034676). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. In support of the manuscript, the NIH had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. Abbott was involved with the initial study design; Abbott had no role in the collection, analysis, or interpretation of data or in the preparation, review, or approval of the manuscript. [Correction added on September 15, 2021 after first online publication: In this section, “Abbvie” has been revised to “Abbott.”] Funding Information: With the exceptions of KHL and SH, authors were funded in part by and/or by Mayo Clinic Study of Aging (National Institutes of Health [NIH] grant number U01 AG006786). SH is a former employee of. KHL had subcontracts with Mayo Clinic on the funded study, and on Mayo Clinic Study of Aging (NIH grant number U01 AG006786). All authors have provided full disclosure of financial, personal, and potential conflicts of interest. RP notes the following disclosures: Roche, Inc., Merck, Inc., Genentech, Inc., Biogen, Inc., Eisai, Inc., consultant. With the exception of items noted here and in the manuscript file, none of the authors have additional conflicts of interest. Publisher Copyright: {\textcopyright} 2021 the Alzheimer's Association",
year = "2022",
month = mar,
doi = "10.1002/alz.12400",
language = "English (US)",
volume = "18",
pages = "393--407",
journal = "Alzheimer's and Dementia",
issn = "1552-5260",
publisher = "Elsevier Inc.",
number = "3",
}