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Health Serv Res. 2019 Aug;54(4):773-781. doi: 10.1111/1475-6773.13134. Epub 2019 Mar 13.

Medicare expenditures attributable to dementia.

Author information

1
Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
2
Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington.
3
National Bureau of Economic Research, Cambridge, Massachusetts.
4
Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, Washington.
5
Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington.
6
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

OBJECTIVE:

To estimate dementia's incremental cost to the traditional Medicare program.

DATA SOURCES:

Health and Retirement Study (HRS) survey-linked Medicare part A and B claims from 1991 to 2012.

STUDY DESIGN:

We compared Medicare expenditures for 60 months following a claims-based dementia diagnosis to those for a randomly selected, matched comparison group.

DATA COLLECTION/EXTRACTION METHODS:

We used a cost estimator that accounts for differential survival between individuals with and without dementia and decomposes incremental costs into survival and cost intensity components.

PRINCIPAL FINDINGS:

Dementia's five-year incremental cost to the traditional Medicare program is approximately $15 700 per patient, nearly half of which is incurred in the first year after diagnosis. Shorter survival with dementia mitigates the incremental cost by about $2650. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services. The incremental cost of dementia was about $7850 higher for females than for males because of sex-specific differential mortality associated with dementia.

CONCLUSIONS:

Dementia's cost to the traditional Medicare program is significant. Interventions that target early identification of dementia and preventable inpatient and post-acute care services could produce substantial savings.

KEYWORDS:

Alzheimer's disease; Medicare; aging; dementia; health care costs

PMID:
30868557
PMCID:
PMC6606539
[Available on 2020-08-01]
DOI:
10.1111/1475-6773.13134

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