Article
Association between healthcare costs and low-value care among people living with dementia
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Authors
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Moritz Platen
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Deutschland
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Anika Rädke
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Deutschland
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Diana Wucherer
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Deutschland
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René Thyrian
- Universitätsmedizin Greifswald, Institut für Community Medicine, Versorgungsepidemiologie und Community Health, Greifswald, Deutschland; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Rostock/Greifswald, Interventionelle Versorgungsforschung, Greifswald, Deutschland
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Wiebke Mohr
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Deutschland
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Franka Mühlichen
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Deutschland
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Wolfgang Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Deutschland; Universitätsmedizin Greifswald, Institut für Community Medicine, Versorgungsepidemiologie und Community Health, Greifswald, Deutschland
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Bernhard Michalowsky
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Deutschland
| Published: | September 27, 2021 |
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Outline
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Background and status of (inter)national research: Amid rising healthcare expenditures and the increasing prevalence of people living with dementia (PwD), avoiding low-value care (LvC), defined as care unlikely to provide a benefit to the patient regarding their preferences, potential harms, costs, or available alternatives, and promoting high-value care (HvC) promises a better quality within the same healthcare budget. However, while rationales for LvC are based primarily on clinical evidence, there is a lack of research referring to costs and economic burden.
Question and objective: For this purpose, this study aims to determine differences in health resource utilization and costs among PwD receiving LvC or HvC and to analyze the associations between healthcare costs and both treatment groups.
Method or hypothesis: This analysis was based on 516 PwD of the DelpHi-MV trial. Health resource utilization was assessed within the baseline assessment using healthcare resource utilization questionnaires. Costs were assessed from payers and societal perspectives. To distinguish between LvC and HvC, guidelines, recommendations against overuse and underuse, or lists publishing potentially inadequate medications were used. The association between PwD who received LvC or HvC and healthcare costs were assessed using multiple linear regression models.
Results: PwD who received LvC significantly less frequently utilized ambulatory and informal care and received less frequently anti-dementia drugs, like memantine. PwD receiving LvC had significantly higher healthcare costs (€ 2,460 vs. € 1,993) due to higher medical care costs (b=2,548; 95% CI 1,284–3,812). There were no differences in utilization between LvC and HvC and planned or acute in-hospital treatments, and no associations between the respective treatment groups and formal and informal care costs.
Discussion: LvC not only harms patients but also burdens payers. Pooled funds for LvC consume resources that are actually needed by payers for prospective dementia care due to the increasing healthcare expenditures and prevalence of PwD. Future research should examine innovative approaches that improve dementia care while avoiding waste from LvC.
Practical implications: A broader evidence base to incorporate the economic burden of LvC among PwD promotes the support for clinicians and also policy-makers in healthcare.
Appeal for practice (science and/or care) in one sentence: Use and promote all digital opportunities available to improve clinician awareness and empower patients.
