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J Alzheimers Dis. 2016;50(1):47-59. doi: 10.3233/JAD-150600.

Economic Analysis of Formal Care, Informal Care, and Productivity Losses in Primary Care Patients who Screened Positive for Dementia in Germany.

Author information

  • 1German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.
  • 2Department of General Business Administration and Health Care Management, Ernst Moritz Arndt University Greifswald, Greifswald, Germany.
  • 3Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany.



The majority of people with dementia (PwD) live at home and require professional formal care and informal care that is generally provided by close relatives.


To determine the utilization and costs of formal and informal care for PwD, indirect costs because of productivity losses of caregivers, and the associations between cost, socio-demographic and clinical variables.


The analysis includes the data of 262 community-dwelling PwD and their caregivers. Socio-demographics, clinical variables, and the utilization of formal care were assessed within the baseline assessment. To evaluate informal care costs, the Resource Utilization in Dementia (RUD) questionnaire was used. Costs were calculated from a social perspective. Associations were evaluated using multiple linear and logistic regression models.


Formal care services were utilized less (26.3%) than informal care (85.1%), resulting in a cost ratio of one to ten(1,646 €; 16,473 €, respectively). In total, 29% of caregivers were employed, and every seventh (14.3%) experienced productivity losses, which corresponded to 1,258 € annually. Whereas increasing deficits in daily living activities were associated with higher formal and higher informal costs, living alone was significantly associated with higher formal care costs and the employment of a caregiver was associated with lower informal care costs.


Informal care contributes the most to total care costs. Living alone is a major cost driver for formal costs because of the lower availability of potential informal care. The availability of informal care is limited and productivity losses are increased when a caregiver is employed.


Alzheimer’s disease; caregivers; cost of illness; dementia; economics; health resources; patient care

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