Schaller S, Mauskopf J, Kriza C, Wahlster P, Kolominsky-Rabas PL. The main cost drivers in dementia: a systematic review. Int J Geriatr Psych. 2015 Feb;30(2):111-29.

Objectives: Due to the increasing prevalence of dementia worldwide combined with limited healthcare expenditures, a better understanding of the main cost drivers of dementia in different care settings is needed.

Methods: A systematic review of COI studies in dementia was conducted from 2003-2012, searching the PubMed (Medline), Cochrane Library, ScienceDirect (EMBASE) and NHS Economics Evaluations Database (NHSEED). Costs (per patient) by care setting were analyzed for total, direct, indirect & informal costs and related to (1) cost perspective and (2) disease severity.

Results: In total, 27 studies from 14 different healthcare systems were evaluated. In the included studies, total annual costs for dementia of up to USD 70,911 per patient (mixed setting) were estimated (average estimate of total costs = USD 30,554). The shares of cost categories in the total costs for dementia indicate significant differences for different care settings. Overall main cost drivers of dementia are nursing home expenditures and home-based long-term care rather than the direct medical costs (inpatient, outpatient services, medication).

Conclusions: The results of this review highlight the significant economic burden of dementia for patients, families and health care systems and thus are important for future health policy planning. The significant variation of cost estimates for different care settings underlines the need to understand and address the financial burden of dementia from both perspectives. For health policy planning in dementia, future cost-of-illness studies should follow a quality standard protocol with clearly defined cost components and separate estimates by care setting and disease severity.

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