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El-Hayek YH, Wiley RE, Khoury CP, Daya RP, Ballard C, Evans AR, Karran M, Molinuevo JL, Norton M, Atri A. Tip of the Iceberg: Assessing the Global Socioeconomic Costs of Alzheimer's Disease and Related Dementias and Strategic Implications for Stakeholders. J Alzheimers Dis 2020; 70:323-341. [PMID: 31256142 PMCID: PMC6700654 DOI: 10.3233/jad-190426] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
While it is generally understood that Alzheimer’s disease (AD) and related dementias (ADRD) is one of the costliest diseases to society, there is widespread concern that researchers and policymakers are not comprehensively capturing and describing the full scope and magnitude of the socioeconomic burden of ADRD. This review aimed to 1) catalogue the different types of AD-related socioeconomic costs described in the literature; 2) assess the challenges and gaps of existing approaches to measuring these costs; and 3) analyze and discuss the implications for stakeholders including policymakers, healthcare systems, associations, advocacy groups, clinicians, and researchers looking to improve the ability to generate reliable data that can guide evidence-based decision making. A centrally emergent theme from this review is that it is challenging to gauge the true value of policies, programs, or interventions in the ADRD arena given the long-term, progressive nature of the disease, its insidious socioeconomic impact beyond the patient and the formal healthcare system, and the complexities and current deficiencies (in measures and real-world data) in accurately calculating the full costs to society. There is therefore an urgent need for all stakeholders to establish a common understanding of the challenges in evaluating the full cost of ADRD and define approaches that allow us to measure these costs more accurately, with a view to prioritizing evidence-based solutions to mitigate this looming public health crisis.
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Affiliation(s)
| | - Ryan E Wiley
- Shift Health, Toronto, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center, Barcelona, Spain.,Paqual Maragall Foundation, Barcelona, Spain
| | | | - Alireza Atri
- Banner Sun Health Research Institute, Banner Health, Sun City, AZ, USA.,Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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2
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Liu W, Lyu T, Zhang X, Yuan S, Zhang H. Willingness-to-pay and willingness-to-accept of informal caregivers of dependent elderly people in Shanghai, China. BMC Health Serv Res 2020; 20:618. [PMID: 32631341 PMCID: PMC7339502 DOI: 10.1186/s12913-020-05481-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/28/2020] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND In order to make optimal long-term care-related decisions, it is important to take a societal perspective. Shanghai is one of the pilot cities of social long-term care insurance in China. However, little knowledge exists about the economic value of the informal care provided to dependent elderly people in China. This paper aims to evaluate the economic value of informal caregiving in Shanghai using the contingent valuation method by their least-preferred care tasks, and identify the associated factors of willingness-to-pay (WTP) and willingness-to-accept (WTA) of the informal caregivers. METHODS This study employed the contingent valuation method to elicit 371 informal caregivers' WTP and WTA for 1 hour of reduction or increase of least-preferred caring tasks in Shanghai. Univariate and multivariate analyses were conducted to explore the associated factors with the WTP and WTA values. RESULTS The average WTP and WTA were 25.31 CNY and 38.66 CNY, respectively. The associated factors with WTP include caregiver's income and caregiver's relationship to the recipient. Care recipient's age, income, least-preferred task by the caregiver, and subscales of Caregiver Reaction Assessment were found to be associated with WTA. The non-responsiveness rates were 26.1 and 33.2% for WTP and WTA questions, respectively. CONCLUSIONS The findings of the current study demonstrated that decision-makers and researchers should take the economic valuation results of informal care into account to make more informed and effective long-term care-related policies and analyses.
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Affiliation(s)
- Wenwei Liu
- College of Philosophy, Law and Political Science, Shanghai Normal University, Shanghai, China.,School of International and Public Affairs, Shanghai Jiao Tong University, Xin Jian Building, 1954 Huashan Rd, Shanghai, 200030, China
| | - Tongzhou Lyu
- College of Philosophy, Law and Political Science, Shanghai Normal University, Shanghai, China
| | - Xiaoyi Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Xin Jian Building, 1954 Huashan Rd, Shanghai, 200030, China
| | - Suwei Yuan
- China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Huimin Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Xin Jian Building, 1954 Huashan Rd, Shanghai, 200030, China.
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Svedbom A, Hadji P, Hernlund E, Thoren R, McCloskey E, Stad R, Stollenwerk B. Cost-effectiveness of pharmacological fracture prevention for osteoporosis as prescribed in clinical practice in France, Germany, Italy, Spain, and the United Kingdom. Osteoporos Int 2019; 30:1745-1754. [PMID: 31270592 DOI: 10.1007/s00198-019-05064-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022]
Abstract
UNLABELLED This study estimated the cost-effectiveness of pharmacological fracture prevention as prescribed in the five largest European countries (EU5) using the IOF reference cost-effectiveness model. Pharmacological fracture prevention as prescribed in clinical practice was cost-saving (provided more QALYs at lower costs) compared to no treatment in each of the EU5. PURPOSE To estimate the real-world cost-effectiveness of pharmacological fracture prevention as prescribed in the five largest European countries by population size: France, Germany, Italy, Spain, and the United Kingdom (UK) (collectively EU5). MATERIALS AND METHODS We analyzed sales data on osteoporosis drugs in each of the EU5 to derive a hypothetical intervention that corresponds to the mix of osteoporosis medication prescribed in clinical practice. The costs for this treatment mix were obtained directly from the sales data, and the efficacy of the treatment mix was estimated by weighing the treatment-specific fracture risk reductions from a published meta-analysis. Subsequently, we estimated the cost-effectiveness using costs per quality adjusted life year (QALY) of the intervention compared to no treatment in each of the EU5 using the International Osteoporosis Foundation (IOF) reference cost-effectiveness model. The model population comprised postmenopausal women, mean age 72 years with established osteoporosis (T-score ≤ - 2.5) among whom 23.6% had a prevalent vertebral fracture. The model was populated with country-specific data from the literature. RESULTS Pharmacological fracture prevention as prescribed in clinical practice was cost-saving (provided more QALYs at lower costs) compared to no treatment in each country. The findings were robust in scenario analyses. CONCLUSIONS Pharmacological fracture prevention as prescribed in clinical practice is cost-saving in each of the EU5. Because of the under-diagnosis and under-treatment of post-menopausal osteoporosis, from a health economic perspective, further cost-savings may be reached by expanding treatment to those at increased risk of fracture currently not receiving any treatment.
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Affiliation(s)
| | - P Hadji
- Frankfurt Center of Bone Disease, Frankfurt/Main, Germany
- Philips-University of Marburg, Marburg, Germany
| | | | | | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - R Stad
- Amgen Europe (GmbH), Suurstoffi 22, P. O. Box 94, CH-6343, Rotkreuz, Switzerland
| | - B Stollenwerk
- Amgen Europe (GmbH), Suurstoffi 22, P. O. Box 94, CH-6343, Rotkreuz, Switzerland.
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De Cola MC, Lo Buono V, Mento A, Foti M, Marino S, Bramanti P, Manuli A, Calabrò RS. Unmet Needs for Family Caregivers of Elderly People With Dementia Living in Italy: What Do We Know So Far and What Should We Do Next? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2017; 54:46958017713708. [PMID: 28617065 PMCID: PMC5798676 DOI: 10.1177/0046958017713708] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Care of the elderly with dementia represents one of the major challenges for the modern society worldwide. The burden of dementia care often falls on the family members, entailing heavy psychosocial and economic consequences. The aim of this study was to evaluate the caregiver's perspective concerning the support for disease management on behalf of the physicians and the local Sicilian administrations (Italy), and the burden of care and effects on their lifestyle, to propose new prevention strategies and service for managing dementia and caregiver's burden. Fifty-nine caregivers of Italian elderly people with dementia (mean age, 73; age range: 63-83) were interviewed, and 55 of them completed an ad hoc self-report questionnaire composed of 54 multiple-choice questions. Our findings suggest that caregivers need more information on the disease's management, as well as on how to deal with the stress due to the disease burden. Moreover, a negative perception about the services offered from the local administration emerged. Assistive technology (AT) could be useful in promoting interaction between general practitioners and specialized centers for diagnosis, pharmacological and psychosocial treatments, and in saving costs. Moreover, case manager could follow patients and support family members within the care pathway, besides collecting and sharing information among the different health professionals involved. Further studies should be aimed at investigating whether AT and/or the use of specific educational strategies could be the right approach for meeting the needs of families living with dementia.
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Affiliation(s)
| | | | - Agata Mento
- 1 IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy
| | - Mariella Foti
- 1 IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy
| | - Silvia Marino
- 1 IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy
| | | | - Alfredo Manuli
- 1 IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy
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Unsupervised Machine Learning for Developing Personalised Behaviour Models Using Activity Data. SENSORS 2017; 17:s17051034. [PMID: 28471405 PMCID: PMC5469639 DOI: 10.3390/s17051034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 12/19/2022]
Abstract
The goal of this study is to address two major issues that undermine the large scale deployment of smart home sensing solutions in people's homes. These include the costs associated with having to install and maintain a large number of sensors, and the pragmatics of annotating numerous sensor data streams for activity classification. Our aim was therefore to propose a method to describe individual users' behavioural patterns starting from unannotated data analysis of a minimal number of sensors and a "blind" approach for activity recognition. The methodology included processing and analysing sensor data from 17 older adults living in community-based housing to extract activity information at different times of the day. The findings illustrate that 55 days of sensor data from a sensor configuration comprising three sensors, and extracting appropriate features including a "busyness" measure, are adequate to build robust models which can be used for clustering individuals based on their behaviour patterns with a high degree of accuracy (>85%). The obtained clusters can be used to describe individual behaviour over different times of the day. This approach suggests a scalable solution to support optimising the personalisation of care by utilising low-cost sensing and analysis. This approach could be used to track a person's needs over time and fine-tune their care plan on an ongoing basis in a cost-effective manner.
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KOCA E, TAŞKAPILIOĞLU Ö, BAKAR M. Caregiver Burden in Different Stages of Alzheimer's Disease. Noro Psikiyatr Ars 2017; 54:82-86. [PMID: 28566965 PMCID: PMC5439478 DOI: 10.5152/npa.2017.11304] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 01/18/2016] [Indexed: 11/22/2022] Open
Abstract
With an increasing number of patients being diagnosed with Alzheimer's disease (AD) daily, it has become one of the major problems in public health. The increase in the number of dementia patients in low- and middle-income countries is expected to be much more than that in developed countries. As a result, the economic burden of dementia, both worldwide and in Turkey, is growing. Moreover, AD leads to emotional burdens and psychological distress in family member(s) and caregiver(s) alongside the patient. Each stage of AD imposes different responsibilities on caregivers, increasing their burden. The suffering and emotional burdens of caregivers from these responsibilities lead to a decreased quality of life and disturbed body physiology. Incapacity, despair, weariness, and loneliness are the hidden emotions of this iceberg. This review aims to gather the results of studies on caregiver burden in different stages of AD, attract attention to those results that may have been ignored in Turkey, and shed light on the solutions required to overcome the problems in caregiving of AD patients.
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Affiliation(s)
- Elif KOCA
- Uludağ Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, Bursa, Türkiye
| | | | - Mustafa BAKAR
- Uludağ Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, Bursa, Türkiye
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Patterns of Objective and Subjective Burden of Informal Caregivers in Multiple Sclerosis. Behav Neurol 2015; 2015:648415. [PMID: 26078487 PMCID: PMC4452831 DOI: 10.1155/2015/648415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/30/2015] [Indexed: 01/24/2023] Open
Abstract
Background. Home
care for patients with Multiple Sclerosis (MS)
relies largely on informal caregivers (ICs).
Methods. We assessed ICs
objective burden (Resource Utilization in
Dementia measuring informal care time (ICT)) and
ICs subjective burden (Zarit Burden Inventory (ZBI)). Results. ICs
(N = 99)
were spouses (70%), mean age 52 years,
assisting disabled patients with a mean EDSS
(Expanded Disability Status Scale) of 5.5, with
executive dysfunction (mean DEX (Dysexecutive questionnaire) of 25) and a duration of MS
ranging from 1 to 44 years. Objective burden was
high (mean ICT = 6.5 hours/day), mostly
consisting of supervision time. Subjective
burden was moderate (mean ZBI = 27.3).
Multivariate analyses showed that both burdens
were positively correlated with higher levels of
EDSS and DEX, whereas coresidency and IC's
female gender correlated with objective burden
only and IC's poor mental health status with
subjective burden only. When considering MS
aggressiveness, it appeared that both burdens
were not correlated with a higher duration of MS
but rather increased for patients with severe
and early dysexecutive function and for patients
classified as fast progressors according to the
Multiple Sclerosis Severity Score.
Conclusion. Evaluation of MS
disability course and IC's personal
situation is crucial to understand the burden
process and to implement adequate interventions
in MS.
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Pimouguet C, Lavaud T, Dartigues JF, Helmer C. Dementia case management effectiveness on health care costs and resource utilization: a systematic review of randomized controlled trials. J Nutr Health Aging 2010; 14:669-76. [PMID: 20922344 DOI: 10.1007/s12603-010-0314-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The growing number of dementia patients leads to both policy, economic and health organization constraints. Many healthcare systems have developed case management programs in order to optimize dementia patients and caregivers care and services delivery. Nevertheless, to what extend case management programs can lead to an improvement of care and expenditures savings is not known. Thus, the objective of this paper was to analyse the efficacy of case management programs on health care cost, institutionalization and hospitalization. A systematic review of randomized controlled trials was therefore conducted of the databases MEDLINE and SCOPUS up to September 2009. Included were English language randomized controlled trials of case management for community dwelling dementia patients and their caregivers evaluating costs, institutionalization and hospitalization. An evaluation of the methodological quality was performed. Thirteen relevant studies concerning 12 trials were identified and included. None of the 7 low quality studies reported positive impact of case management on the outcomes of interest. Among the 6 good quality studies, 4 reported positive impact on institutionalization delay, institutionalization length or nursing home admission rate. In none of the good quality studies was evidence found for savings in health care expenditures or reduction in hospitalization recourse. The weak convincing evidences from randomized trials do not allow any conclusion about the efficacy of case management for dementia patient and caregivers on costs and resource utilization. Further research should focus on determining subgroups of caregivers who could benefit the most from case management.
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Affiliation(s)
- C Pimouguet
- INSERM, U 897, and Université Victor Segalen Bordeaux 2, 146 rue Leo Saignat, 33 076 Bordeaux Cedex, France.
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