Direct medical costs and source of cost differences across the spectrum of cognitive decline: a population-based study.
Direct medical costs and source of cost differences across the spectrum of cognitive decline: a population-based study.
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DOI：
10.1016/j.jalz.2015.01.007
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发表时间：
2015-08
期刊：
影响因子：
--
通讯作者：
Petersen RC
中科院分区：
文献类型：
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作者：
Leibson CL;Long KH;Ransom JE;Roberts RO;Hass SL;Duhig AM;Smith CY;Emerson JA;Pankratz VS;Petersen RC
客观的成本估计和成本差异的来源需要在整个认知范围内，包括认知正常（CN），轻度认知障碍（MCI），新发现的痴呆症和流行性痴呆症。受试者是马约诊所老龄化分层随机抽样研究的一个子集，来自明尼苏达州奥姆斯特德县，70-89岁的居民。一名神经科医生审查了与提供者相关的医疗记录，以确定痴呆症的患病率（审查日期=索引）。其余受试者被邀请参加前瞻性临床/神经心理学评估;参与者被分类为CN、MCI或新发现痴呆（评估日期=索引）。使用与供应商相关的行政数据估算了1年指数前的医疗服务/程序成本（不包括间接和长期护理成本）。我们估计了医疗服务地点和共病（包括和不包括神经精神诊断）对类别间成本差异的贡献。CN、MCI、新发现痴呆和流行性痴呆的年平均医疗费用分别为6，042美元、6，784美元、9，431美元和11，678美元。住院费用占流行性痴呆总费用的70%，并解释了CN与流行性和新发现的痴呆之间的差异。门诊费用占CN和MCI之间的差异。年龄，性别，教育调整后的差异达到显着CN与新发现的和患病的痴呆症和MCI与患病的痴呆症。在考虑所有共病诊断后，类别间差异减少（例如，痴呆症患病率减去MCI（从4,842美元到3,575美元）;新发现的痴呆症减去CN（从3,578美元到711美元）。从合并症调整中排除神经精神疾病诊断后，类别间差异倾向于恢复到更大的差异。CN和MCI之间的成本估计没有显着差异。MCI和流行性痴呆之间的实质性差异反映了痴呆的住院费用高，并出现部分相关的共同发生的精神障碍。这种比较有助于为模型提供信息，这些模型旨在确定在何处、何时以及为哪些个人提出的干预措施可能具有成本效益。
Objective cost estimates and source of cost differences are needed across the spectrum of cognition, including cognitively normal (CN), mild-cognitive-impairment (MCI), newly-discovered dementia, and prevalent dementia. Subjects were a subset of the Mayo Clinic Study of Aging stratified-random sampling of Olmsted County, MN, residents aged 70-89 years. A neurologist reviewed provider-linked medical records to identify prevalent-dementia (review date=index). Remaining subjects were invited to participate in prospective clinical/neuropsychological assessments; participants were categorized as CN, MCI, or newly-discovered-dementia (assessment date=index). Costs for medical services/procedures 1-year pre-index (excluding indirect and long-term care costs) were estimated using line-item provider-linked administrative data. We estimated contributions of care-delivery site and comorbid conditions (including and excluding neuropsychiatric diagnoses) to between-category cost differences. Annual mean medical costs for CN, MCI, newly-discovered-dementia, and prevalent-dementia were $6,042, $6,784, $9,431, $11,678 respectively. Hospital inpatient costs contributed 70% of total costs for prevalent dementia and accounted for differences between CN and both prevalent and newly-discovered dementia. Ambulatory costs accounted for differences between CN and MCI. Age-, sex-, education-adjusted differences reached significance for CN versus newly-discovered and prevalent-dementia and for MCI versus prevalent-dementia. After considering all comorbid diagnoses, between-category differences were reduced (e.g., prevalent-dementia minus MCI (from $4,842 to $3,575); newly-discovered-dementia minus CN (from $3,578 to$711). Following exclusion of neuropsychiatric diagnoses from comorbidity adjustment, between-category differences tended to revert to greater differences. Cost estimates did not differ significantly between CN and MCI. Substantial differences between MCI and prevalent dementia reflected high inpatient costs for dementia and appear partly related to co-occurring Mental Disorders. Such comparisons can help inform models aimed at identifying where, when, and for which individuals proposed interventions might be cost-effective.