Patterns of healthcare utilization and costs for vascular dementia in a community-dwelling population

Article type: Research Article

Authors: Hill, Jerrold^{a; *} | Fillit, Howard^{a; b} | Shah, Sonali N.^c | del Valle, Megan C.^c | Futterman, Robert^d

Affiliations: [a] Institute for the Study of Aging, New York, NY, USA | [b] Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, NY, USA | [c] Pfizer, Inc., New York, NY, USA | [d] Medical and Quality Informatics, HIP Health Plan of New York Inc., NY, USA

Correspondence: [*] Corresponding author: Jerrold Hill, Institute for the Study of Aging, 1414 Ave. of the Americas, Suite 1502, New York, NY 10019, USA. Tel.: +1 212 901 8007; Fax: +1 212 935 2408; E-mail: jhill@aging-institute.org.

Abstract: Background:While vascular dementia (VaD) is the second most prevalent dementia diagnosis, little is known about healthcare use and costs for VaD. Purpose:This study compares the healthcare use and costs of community-dwelling patients with VaD to patients with Alzheimer's disease (AD), other dementias (OD), cerebrovascular disease without dementia (CVD), and patients without dementia or cerebrovascular disease (controls). Methods:Using diagnoses codes from medical claims and encounter records, 678 VaD, 1,722 AD, 957 OD, 2,718 CVD, and 14,023 controls were identified from patients enrolled in a 100,000-member group practice Medicare HMO during 1999–2002. Annual healthcare use and costs of the study groups were compared, using regression analysis to control for patient characteristics. Results:VaD patients had the highest annual costs, $14,387, followed by $10,716 for OD, $8,254 for CVD, and $7,839 for AD, and $5,494 for controls (p<0.0001 for all comparisons to VaD). Despite higher total direct costss, VaD patients had lower costs for physician visits and prescription drugs compared with all study groups except OD. In contrast, CVD patients had the highest costs for these services. Moreover, hospital admissions for VaD were nearly twice those for CVD, and hospital days for VaD nearly three times those for CVD, despite the high prevalence of cardiovascular conditions for both VaD and CVD. Conclusions:VaD patients had higher healthcare costs compared to all other patient groups. The substantially higher costs for VaD compared to CVD and the differences in use of healthcare services by VaD compared to CVD suggest that dementia, not cerebrovascular disease, is a major source of the cost differences. Lower costs for physician visits and prescription drugs for VaD suggest possible opportunities for improving ambulatory care and preventing high-cost hospitalizations.

Keywords: Vascular dementia, healthcare cost, healthcare utilization, Alzheimer's disease

DOI: 10.3233/JAD-2005-8105

Journal: Journal of Alzheimer's Disease, vol. 8, no. 1, pp. 43-50, 2005