Kosten der Alzheimer-Erkrankung in Deutschland – aktuelle Ergebnisse der GERAS-Beobachtungsstudie

Zusammenfassung

Zielsetzung: Die Studie ermittelte den Ressourceneinsatz und die Gesamtkosten der Alzheimer-Demenz (AD), stratifiziert nach Schweregrad. Dazu wurden die Daten aus deutschen Privathaushalten von 552 Patienten mit leichter (n = 228), mittlerer (n = 157) oder mittelschwerer/schwerer (n = 167) AD ausgewertet, die an einer 18-monatigen Beobachtungsstudie (GERAS) teilgenommen hatten.

Methodik: Demografische Daten und Charakteristika von Patienten und Pflegenden zu Studienbeginn wurden dokumentiert. Informationen zum Ressourceneinsatz und die aufgewendete Zeit für die informelle Pflege durch pflegende Angehörige wurden mithilfe des „Resource Utilization in Dementia“-Fragebogens (RUD) ermittelt. Die gesellschaftlichen Gesamtkosten (direkte Gesundheits- und Pflege- /Unterstützungskosten der Patienten, Gesundheitskosten der pflegenden Angehörigen und informelle Pflegekosten) wurden basierend auf den erhobenen Daten errechnet.

Ergebnisse: Die durchschnittlichen gesellschaftlichen Gesamtkosten pro Jahr (Kostendaten für 2010) unterschieden sich signifikant (p < 0,001) für Patienten mit leichter (15 739 EUR), mittlerer (28 941 EUR) und mittelschwerer/schwerer AD (44 662 EUR). Die informellen Pflegekosten hatten den größten Anteil an den gesellschaftlichen Gesamtkosten: 49 % bei leichter, 55 % bei mittlerer und 64 % bei mittelschwerer/schwerer AD.

Schlussfolgerung: Die gesellschaftlichen Gesamtkosten für im eigenen Haushalt lebende Alzheimer-Patienten erhöhen sich mit zunehmender Verschlechterung der Krankheit. Die informellen Kosten der Pflegenden sind dabei der bestimmende Kostenfaktor.

Abstract

Aim: To analyse baseline data from 552 community-dwelling German patients with mild (n = 228), moderate (n = 157) or moderately severe/severe (n = 167) AD, who participated in a 18-month observational study (GERAS) conducted in three European countries aiming at determining resource use and total costs associated with Alzheimer’s disease (AD), stratified by AD severity at baseline.

Method: Patient and caregiver demographics and baseline characteristics were documented. Resource use information and time spent on informal care by nonprofessional caregivers was obtained using the Resource Utilization in Dementia instrument. Total societal costs at baseline were estimated from patients’ healthcare and social care costs, and from caregivers’ healthcare and informal care costs in the month prior to baseline.

Results: Estimated mean annual total societal costs (2010 values) per patient at baseline differed significantly (p < 0.001) between groups with mild (€15 739), moderate (€28 941) and moderately severe/severe AD (€44 662). Informal care costs were the largest contributor to total societal costs, comprising 49, 55 and 64 % of the total societal costs of mild, moderate and moderately severe/severe AD, respectively.

Conclusion: Total societal costs of AD in community-dwelling individuals increase as disease severity worsens. Caregiver informal care costs were the major cost component at all levels of AD severity.

Schlüsselwörter

Alzheimer-Krankheit - Belastung der pflegenden Angehörigen - Kosten - Deutschland - Beobachtungsstudie

Key Words

Alzheimer’s disease - caregiver burden - costs - Germany - observational study

• Literatur

• 1 Wimo A, Jönsson L, Bond J et al. The worldwide economic impact of dementia 2010. Alzheimers Dement 2013 9: 1-11.e3
• 2 Prince M, Bryce R, Albanese E et al. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement 2013; 9: 63-75.e2
• 3 Gustavsson A, Svensson M, Jacobi F. CDBE 2010 Study Group et al. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011; 21: 718-779
• 4 Qiu C, von Strauss E, Bäckman L et al. Twenty-year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden. Neurology 2013; 80: 1888-1894
• 5 Leicht H, Heinrich S, Heider D et al. Net costs of dementia by disease stage. Acta Psychiatr Scand 2011; 124: 384-395
• 6 Leicht H, König HH, Stuhldreher N et al. AgeCoDe study group (Predictors of costs in dementia in a longitudinal perspective. PLoS One 2013; 8: e70018
• 7 Schwarzkopf L, Menn P, Kunz S et al. Costs of care for dementia patients in community setting: an analysis for mild and moderate disease stage. Value Health 2011; 14: 827-835
• 8 Schwarzkopf L, Menn P, Leidl R et al. Excess costs of dementia disorders and the role of age and gender – an analysis of German health and long-term care insurance claims data. BMC Health Serv Res 2012; 12: 165
• 9 Schwarzkopf L, Menn P, Leidl R et al. Are community-living and institutionalized dementia patients cared for differently? Evidence on service utilization and costs of care from German insurance claims data. BMC Health Serv Res 2013; 13: 2
• 10 von der Schulenburg JM, Schulenburg I, Horn R. Cost of treatment and cost of care for Alzheimer’s disease in Germany. In: Wimo A, Jönsson B, Karlsson G, et al. (Hrsg) The Health Economics of Dementia. Chichester: John Wiley & Sons; 1998: 217-230
• 11 Hallauer JF, Schons M, Smala A et al. Untersuchung von Krankheitskosten bei Patienten mit Alzheimer-Erkrankung in Deutschland. Gesundheitsökonomie und Qualitätsmanagement 2000; 5: 73-79
• 12 Kiencke P, Rychlik R, Grimm C et al. Cost of illness in Alzheimer’s disease. Med Klin (Munich) 2010; 105: 327-333
• 13 Kiencke P, Daniel D, Grimm C et al. Direct costs of Alzheimer‘s disease in Germany. Eur J Health Econ 2011; 12: 533-539
• 14 Reese JP, Hessmann P, Seeberg G et al. Cost and care of patients with Alzheimer‘s disease: clinical predictors in German health care settings. J Alzheimers Dis 2011; 27: 723-736
• 15 Brüggenjürgen B, Andersohn F, Willich SN. Cost attributable to Alzheimer’s disease in Germany. Alzheimers Dement 2012; 8 (04) P237 http://www.deepdyve.com/lp/elsevier/cost-attributable-to-alzheimer-s-disease-in-germany-FpSOcDV4lf (zugegriffen: 19.11.2013)
• 16 Wimo A, Reed CC, Dodel R et al. The GERAS study: a prospective observational study of costs and resource use in community dwellers with Alzheimer's disease in three European countries--study design and baseline findings. J Alzheimers Dis 2013; 36: 385-399
• 17 Wimo A, Wetterholm AL, Mastey V et al. Evaluation of resource utilization and caregiver time in anti-dementia drug trials (a quantitative battery). In: Wimo A, Jonsson B, Karlsson G, (Hrsg) The Health Economics of Dementia. London: John Wiley and Sons; 1998: 465-499
• 18 Folstein MF, Folstein SE, McHugh PR. „Mini-mental state.“ A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198
• 19 Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry 1984; 141 (11) 1356-1364
• 20 National Institute for Health and Clinical Excellence. Health technology appraisal. Donepezil, galantamine, rivastigmine and memantine for the treatment of mild to moderate Alzheimer's disease. 2009 (Part review of TA 111) http://www.nice.org.uk/nicemedia/live/12248/45548/45548.pdf (zugegriffen: 19.11.2013)
• 21 Galasko D, Schmitt F, Thomas R et al. Detailed assessment of activities of daily living in moderate to severe Alzheimer’s disease. J Int Neuropsychol Soc 2005; 11: 446-453
• 22 Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997; 48 (Suppl. 06) 10-16
• 23 Kind P. The EuroQol instrument: an index of health-related quality of life. In: Spilker B, (Hrsg) Quality of life and pharmacoeconomics in clinical trials, 2nd ed. Philadelphia: Lippincott-Raven Publishers; 1996: 191-201
• 24 Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist 1980; 20: 649-655
• 25 Graf von der Schulenburg JM, Greiner W, Jost F. Hanover Consensus Group et al. German recommendations on health economic evaluation: third and updated version of the Hanover Consensus. Value in Health 2008; 11: 539-544
• 26 IQWiG Arbeitspapier zur Kostenbestimmung Version 1.0.
• 27 Gustavsson A, Brinck P, Bergvall N et al. Predictors of costs of care in Alzheimer’s disease: a multinational sample of 1222 patients. Alzheimers Demen 2011; 7: 318-327
• 28 Kobelt G, Berg J, Lindgren P et al. Cost and quality of life of multiple sclerosis in Germany. Eur J Health Econ 2006; 7 (Suppl. 02) S34-S44
• 29 Costa N, Derumeaux H, Rapp T et al. Methodological considerations in cost of illness studies on Alzheimer disease. Health Econ Rev 2012; 2: 18
• 30 Mauskopf J, Mucha L. A review of the methods used to estimate the cost of Alzheimer’s disease in the United States. Am J Alzheimers Dis Other Demen 2011; 26: 298-309
• 31 Wübker A, Zwakhalen S, Challis D et al. Cost of care for people with dementia just before and after nursing home placement: primary data from eight European countries. Eur J of Health Econ 2014; published online 29. Juli 2014
• 32 Deutsche Gesellschaft für Neurologie (Hrsg) S3-Leitlinie „Demenzen“: Langversion. Diagnose- und Behandlungsleitlinie Demenz. Interdisziplinäre S3-Praxisleitlinien, Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN). 2009 2010 1st ed. http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/kurzversion-leitlinien/s3-leitlinie-demenz-lf.pdf (zugegriffen: 19.11.2013)
• 33 Reynish E, Cortes F, Andrieu S et al. The ICTUS study: a prospective longitudinal observational study of 1380 AD patients in Europe. Study design and baseline characteristics of the cohort. Neuroepidemiology 2007; 29: 29-38
• 34 Haro JM, Kahle-Wrobleski K, Bruno G et al. Analysis of burden in caregivers of people with Alzheimer’s disease using self-report and supervision hours. J Nutr Health Aging 2014; 18: 677-684
• 35 Jakob A, Busse A, Riedel-Heller SG et al. Prävalenz und Inzidenz von Demenzerkrankungen in Alten- und Altenpflegeheimen im Vergleich mit Privathaushalten. Z Gerontol Geriatr 2002; 35: 474-481
• 36 Eisele M, van den Bussche H, Koller D et al. Utilization patterns of ambulatory medical care before and after the diagnosis of dementia in Germany--results of a case-control study. Dement Geriatr Cogn Disord 2010; 29: 475-483
• 37 Evans C, Crawford B. Patient self-reports in pharmacoeconomic studies. Their use and impact on study validity. Pharmacoeconomics 1999; 15: 241-256
• 38 Razani J, Kakos B, Orieta-Barbalace C et al. Predicting caregiver burden from daily functional abilities of patients with mild dementia. J Am Geriatr Soc 2007; 55: 1415-1420