Article
Association of mild cognitive impairment with health care utilization and costs in a population with high risk for dementia
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Authors
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Rebecca Thiel
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
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Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Germany
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Walter-Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
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Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany; Centre for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Germany
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Hanna Kaduszkiewicz
- Institute of General Practice, University of Kiel, Germany
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René Thyrian
- Centre for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Germany
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Birgitt Wiese
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
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Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
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Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| Published: | September 10, 2024 |
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Outline
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Background: The number of dementia cases is rising worldwide. Additionally, population aging increased the number of people who are at-risk of dementia and are diagnosed with mild cognitive impairment (MCI), as a preliminary stage of dementia. Dementia is associated with increased resource utilization, and social and health care costs. Which factors are associated with resource utilization and health care costs of people with MCI is largely unclear.
Objective: Determine the determinants of resource utilization and costs in people at-risk for dementia with a focus on MCI.
Methods: The study analyzed data from the German AgeWell.de trial. The study recruited participants with a high number of prevalent risk factors for dementia (CAIDE score ≥ 9) between 60–77 years. The sample had a high prevalence of MCI (8.82%). Data on 4-month health care utilization were collected. To categorize the determinants of resource use, we applied the Andersen model. Primary outcomes were the utilization (yes/no) and the frequency (days) of health care utilization as well as the health care costs.
Results: A total of n=819 participants were analyzed. There was a high utilization of outpatient services and medication. Ten per-cent were hospitalized while the nursing care sector was used rarely (informal 6.4%, formal 2.2%). The MCI diagnosis was not associated with increased service utilization but significantly increased medication costs. Need factors, such as health scores (EQ-5D, IADL) and morbidities were associated with the utilization of inpatient, outpatient, informal care and health care costs. Age was associated with lower inpatient utilization. Other determinants, as gender, health insurance, living situation and education had a minor impact on single categories.
Implication for research and/or (healthcare) practice: Although MCI can predict dementia, we did not confirm an association between resource utilization and worsening cognitive functioning in an at-risk population. MCI was weakly associated with medication costs, which approved the association between MCI and increased health costs. Despite this, we confirmed the association of need factors, such as lower health scores, worse quality of life (EQ-5D) and morbidities with resource utilization. A minor impact of the health insurance was expected due to the affordability of health care services through the statutory health insurance in Germany. Further studies of determinants of resource utilization in people at-risk for dementia and high MCI prevalence, especially in the nursing care sector are needed.
Funding: Individual funding (BMG, DRV, BMBF, DFG, etc); Project name: AgeWell.de – Eine multizentrische cluster-randomisierte kontrollierte Multikomponenten-Interventionsstudie zur Prävention kognitiver Abbauprozesse bei älteren Hausarztpatienten; Grant number: 01GL1704F
