The Price to Pay

Mov Disord. 2013 Mar;28(3):319-26. doi: 10.1002/mds.25328. Epub 2013 Feb 12.
An economic model of Parkinson’s disease: implications for slowing progression in the United States.
Johnson SJ1, Diener MD, Kaltenboeck A, Birnbaum HG, Siderowf AD.
Author information
Multiple studies describe progression, dementia rates, direct and indirect costs, and health utility by Hoehn and Yahr (H&Y) stage, but research has not incorporated these data into a model to evaluate possible economic consequences of slowing progression. This study aimed to model the course of Parkinson’s disease (PD) and describe the economic consequences of slower rates of progression. A Markov model was developed to show the net monetary benefits of slower rates of progression. Four scenarios assuming hypothetical slower rates of progression were compared to a base case scenario. A systematic literature review identified published longitudinal H&Y progression rates. Direct and indirect excess costs (i.e., healthcare costs beyond what similar patients without PD would incur), mortality rates, dementia rates, and health utility were derived from the literature. Ten publications (N = 3,318) were used to model longitudinal H&Y progression. Base case results indicate average excess direct costs of $303,754, life-years of 12.8 years and quality-adjusted life-years of 6.96. A scenario where PD progressed 20% slower than the base case resulted in net monetary benefits of $60,657 ($75,891 including lost income) per patient. The net monetary benefit comes from a $37,927 decrease in direct medical costs, 0.45 increase in quality-adjusted life-years, and $15,235 decrease in lost income. The scenario where PD progression was arrested resulted in net monetary benefits of $442,429 per patient. Reducing progression rates could produce significant economic benefit. This benefit is strongly dependent on the degree to which progression is slowed.
Copyright © 2013 Movement Disorder Society.
PMID: 23404374 DOI: 10.1002/mds.25328

Popul Health Metr. 2016 Nov 3;14:37. eCollection 2016.
Alzheimer’s and other dementias in Canada, 2011 to 2031: a microsimulation Population Health Modeling (POHEM) study of projected prevalence, health burden, health services, and caregiving use.
Manuel DG1, Garner R2, Finès P2, Bancej C3, Flanagan W2, Tu K4, Reimer K5, Chambers LW6, Bernier J2.
Author information
Worldwide, there is concern that increases in the prevalence of dementia will result in large demands for caregivers and supportive services that will be challenging to address. Previous dementia projections have either been simple extrapolations of prevalence or macrosimulations based on dementia incidence.
A population-based microsimulation model of Alzheimer’s and related dementias (POHEM:Neurological) was created using Canadian demographic data, estimates of dementia incidence, health status (health-related quality of life and mortality risk), health care costs and informal caregiving use. Dementia prevalence and 12 other measures were projected to 2031.
Between 2011 and 2031, there was a projected two-fold increase in the number of people living with dementia in Canada (1.6-fold increase in prevalence rate). By 2031, the projected informal (unpaid) caregiving for dementia in Canada was two billion hours per year, or 100 h per year per Canadian of working age.
The projected increase in dementia prevalence was largely related to the expected increase in older Canadians, with projections sensitive to changes in the age of dementia onset.
Alzheimer disease; Computer simulation; Dementia; Health planning; Health status; Home care services; Outcome assessment (Health Care); Population dynamics; Quality of life; Time factors
PMID: 27822143 PMCID: PMC5095994 DOI: 10.1186/s12963-016-0107-z With the first of the baby boomer generation now turning 65, the U.S. population aged 65 and over is expected to double by
2030. Although Alzheimer’s is not normal aging, age is the biggest risk factor for the disease. Taken together, these factors will result in Public Policy Office 202 393 7737 p
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Washington, DC 20005-6105
more and more Americans living with Alzheimer’s – as many as 16 million by 2050, when there will be nearly one million new cases
each year. Due to these projected increases, the graying of America threatens the bankrupting of America. Caring for people with
Alzheimer’s will cost all payers – Medicare, Medicaid, individuals, private insurance and HMOs — $20 trillion over the next 40 years,
enough to pay off the national debt and still send a $10,000 check to every man, woman and child in America. In 2012, America will
have spent an estimated $200 billion in direct costs for those with Alzheimer’s, including $140 billion in costs to Medicare and Medicaid.
Average per person Medicare costs for those with Alzheimer’s and other dementias are three times higher than those without these
conditions. Average per senior Medicaid spending is 19 times higher.

Parkinsonism Relat Disord. 2007 Sep;13 Suppl:S8-S12. Epub 2007 Aug 16.
The economic impact of Parkinson’s disease.
Findley LJ1.
Author information
Patients with Parkinson’s disease (PD) experience progressive disability and reduced quality of life due to both motor and non-motor complications. The cost of illness escalates as PD progresses, placing an economic burden on the healthcare system, society and patients themselves. Overall cost estimates vary from country to country, but the largest component of direct cost is typically inpatient care and nursing home costs, while prescription drugs are the smallest contributor. Indirect costs arising from lost productivity and carer burden tend to be high. The total cost in the UK has been estimated to be between pound 449 million and pound 3.3 billion annually, depending on the cost model and prevalence rate used. Management strategies that minimise the impact of disease progression and maximise quality of life should help ensure optimal resource utilisation.
PMID: 17702630 DOI: 10.1016/j.parkreldis.2007.06.003

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Alzheimers Dement. 2015 Aug;11(8):887-95. doi: 10.1016/j.jalz.2015.06.1889. Epub 2015 Jul 21.
Medical costs of Alzheimer’s disease misdiagnosis among US Medicare beneficiaries.
Hunter CA1, Kirson NY2, Desai U3, Cummings AK3, Faries DE1, Birnbaum HG3.
Author information
Recent developments in diagnostic technology can support earlier, more accurate diagnosis of non-Alzheimer’s disease (AD) dementias.
To evaluate potential economic benefits of early rule-out of AD, annual medical resource use and costs for Medicare beneficiaries potentially misdiagnosed with AD prior to their diagnosis of vascular dementia (VD) or Parkinson’s disease (PD) were compared with that of similar patients never diagnosed with AD.
Patients with prior AD diagnosis used substantially more medical services every year until their VD/PD diagnosis, resulting in incremental annual medical costs of approximately $9,500-$14,000. However, following their corrected diagnosis, medical costs converged with those of patients never diagnosed with AD.
The observed correlation between timing of correct diagnosis and subsequent reversal in excess costs is strongly suggestive of the role of misdiagnosis of AD – rather than AD comorbidity – in this patient population. Our findings suggest potential benefits from earlier, accurate diagnosis.
Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
Alzheimer’s disease; Economic impact; Medicare; Misdiagnosis; Parkinson’s disease; Vascular dementia
PMID: 26206626 DOI: 10.1016/j.jalz.2015.06.1889

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