Call for a Uniform Strategy of Collecting Alzheimer's Disease Costs: A Review and Meta-Analysis

The Excess Direct Social Costs of Dementia-Related Neuropsychiatric Symptoms: A Regionwide Cohort Study Beyond Silos

OBJECTIVES

To estimate the excess formal social costs or direct non-healthcare costs of dementia-related neuropsychiatric symptoms (NPS).

METHODS

The presence of dementia, NPS, antipsychotic and antidepressant use, somatic and psychiatric comorbidities, and formal social benefits were studied in a regionwide cohort of all 60-year-old and older individuals. A random forest-based algorithm identified NPS, and 2-part regression models and entropy balance were used.

RESULTS

Of the 215 859 individuals, 7553 (3.50%) had dementia, 74 845 (34.7%) had some NPS, and 20 787 (9.63%) received long-term care benefits. Notably, nearly two-thirds (63.9%) of people with dementia received benefits. The probability of having social costs varied markedly with age (odds ratio [OR] 12.28 [10.17-14.82] for >90-year-olds category), and the presence of dementia (OR 7.36 [6.13-8.84]) or NPS (OR 3.23 [2.69-3.88]). NPS (relative change [RC] 1.39 [1.31-1.49]) and dementia (RC 1.32 [1.24-1.41]) were associated with higher average benefit costs. Low socioeconomic status was significantly associated with both a higher probability of receiving benefits (OR 1.52 [1.38-1.68]) and higher costs of their provision (RC 1.18 [1.15-1.21]).

CONCLUSIONS

The burden of caring for NPS is greater than that indicated by the literature as these symptoms multiply the social costs of dementia by more than 3, owing to the greater use of residential care and formal coverage reaching more patients than that indicated by the literature. The greater presence of dementia and NPS in the population of lower socioeconomic status indicates an inequality in health attenuated by greater use of social benefits.

Economic burden and quality of life of patients with dementia in China: a systematic review and meta-analysis

BACKGROUND

China has the largest number of dementia patients worldwide. The prolonged course of dementia has a serious negative impact on the economy and quality of life of patients and their families.

OBJECTIVE

The purpose of this study was to conduct a systematic review and meta-analysis of the existing literature about economic burden and quality of life of people with dementia in China.

METHODS

Six databases were systematically searched for observational studies of the economic burden or quality of life of dementia that were published before June 30, 2024. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

RESULTS

A total of 36,411 papers were identified, and 21 studies met the inclusion criteria. The annual economic burden of dementia was 20,893 RMB (3,104 USD). The total costs associated with mild, moderate, and severe dementia were 16,619 RMB (2,469 USD), 22,283 RMB (3,311 USD), and 34,611 RMB (5,143 USD), respectively, indicating that the cost increased significantly with increasing dementia severity. In terms of the quality of life, the combined total score for the Quality of Life-Alzheimer's Disease scale was 30.11, with lower scores for the Housekeeping, Recreation, and Memory items.

CONCLUSIONS

Dementia imposes a significant economic and quality of life burden on Chinese patients. The government should pay more attention to dementia and develop a comprehensive prevention and treatment system to reduce the heavy burden of dementia.

TRIAL REGISTRATION

This systematic review has the registration number CRD42022374470 on PROSPERO.

The Humanistic and Economic Burden of Alzheimer's Disease

Alzheimer's disease (AD) is the leading cause of cognitive impairment and dementia in older individuals (aged ≥ 65 years) throughout the world. As a result of these progressive deficits in cognitive, emotional, and physical function, AD dementia can cause functional disability and loss of independence. To gain a deeper understanding of the recent literature on the burden of AD, including that of mild cognitive impairment (MCI) due to AD, we conducted a comprehensive targeted review of the PubMed-indexed literature (2014 to 2021) to examine the humanistic and economic burden of AD (including MCI) in North America, Europe, and Asia. Our literature review identified a range of factors associated with quality of life (QoL): some factors were positively associated with QoL, including caregiver relationship, religiosity, social engagement, and ability to engage in activities of daily living (ADL), whereas other factors such as neuropsychiatric symptoms were associated with poorer QoL. While patient- and proxy-rated QoL are highly correlated in patients with early AD dementia, proxy-rated QoL declines more substantially as severity worsens. The maintenance of self-reported QoL in patients with more severe AD dementia may be due to lack of awareness or to adaptation to circumstances. Compared to persons with normal cognition, MCI is associated with a greater cost burden, and individuals with MCI exhibit worse QoL. Key drivers of the societal economic burden of AD include disease severity, dependence level, institutionalization, and comorbidity burden. Evaluation of the impact of a hypothetical disease-modifying treatment delaying the progression from MCI to AD has suggested that such a treatment may result in cost savings.

Overview of Meta-Analyses of Five Non-pharmacological Interventions for Alzheimer's Disease

Background: Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive memory deficits, cognitive decline, and spatial disorientation. Non-pharmacological interventions to treat AD have been reported in many meta-analyses (MAs), but robust conclusions have not been made because of variations in the scope, quality, and findings of these reviews.

Objective: This work aimed to review existing MAs to provide an overview of existing evidence on the effects of five non-pharmacological interventions in AD patients on three outcomes: Mini-Mental State Examination (MMSE), activities of daily living (ADL), and Alzheimer's Disease Assessment Scale-cognitive section (ADAS-cog).

Methods: The databases PubMed, Cochrane Library, Embase, and Web of Science were searched to collect MAs of non-pharmacological interventions for AD. Two reviewers independently conducted literature screening, data extraction, and quality assessment. We assessed the quality of MAs with the Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and assessed the evidence quality for significant outcomes using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results: We found 10 eligible MAs, which included between three (133 patients) and 15 randomized trials (1,217 patients), and five non-pharmacological interventions, namely, acupuncture therapy (40%), exercise intervention (30%), music therapy (10%), cognitive intervention (10%), and repetitive transcranial magnetic stimulation (rTMS) (10%). All the included MAs were critically low to low quality by AMSTAR 2. Acupuncture therapy and exercise intervention showed the preliminary potential to improve ADL and MMSE. rTMS and acupuncture therapy show benefits in decreasing ADAS-cog, and there were some evidence of improved MMSE with cognitive intervention. All these outcomes scored very low quality to moderate quality of evidence on the GRADE system.

Conclusions: Non-pharmacological therapy shows promise for the treatment of AD, but there is still a lack of high-quality evidence. In the future, the quality of the original research needs to be improved, and strictly designed MAs should be carried out following methodological requirements.

Tip of the Iceberg: Assessing the Global Socioeconomic Costs of Alzheimer's Disease and Related Dementias and Strategic Implications for Stakeholders

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.

Predictions of Alzheimer's disease treatment and care costs in European countries

Background

Given the increasing lifespan of the elderly and the higher proportion of older people in the global population, the incidence rate of neurodegenerative diseases is increasing. The aim of this study is to evaluate, by means of computer simulations, developments in the costs of treating and caring for people suffering from Alzheimer’s disease (AD) in the EU 28 by 2080, while assuming the introduction of drug administrations at various disease stages.

Methods

Impact analysis leverages a mathematical model that compares five different population development scenarios when introducing different types of drugs to the scenarios but without changing the treatment. Changes in the economic burden are considered as of 2023, when new drugs are expected to enter the market.

Findings

The results of the simulations show that by prolonging the length of a person’s ‘stay’ in the Mild, Moderate, or Severe stage, the total cost of care for all persons with AD will increase by 2080. For individual scenarios, the percentage of patients and costs increased as follows: Mild by one year, by 10.61%; Mild by two years, by 17.73%; Moderate by one year, by 16.79%; Moderate by two years, by 34.88%; and Severe by one year, by 23.79%. The change in cost development when prolonging the stay in the Mild cognitive impairment stage (by lowering the incidence by 10%, 30%, or 50%) reduced the cost (by 4.88%, 16.78% and 32.48%, respectively).

Interpretation

The results unambiguously show that any intervention prolonging a patient’s stay in any stage will incur additional care costs and an increase in the number of persons with AD. Therefore, extending lifespan is important in terms of improving the quality of life of patients, and the introduction of new drugs must consider the additional costs imposed upon society.