Real world outcomes, healthcare utilisation and costs of Alzheimer's disease in England

• Published in: Aging and health research 2024-03, Vol.4 (1), p.100180, Article 100180
• Main Authors: Edwards, Sophie, Trepel, Dominic, Ritchie, Craig, Hahn-Pedersen, Julie Hviid, Robinson, Danielle E, Chan, Mei Sum, Bray, Benjamin D, Clark, Alice, Ivkovic, Milana, Michalak, Wojciech, Wichmann, Christian Ahmad, Evans, Marc
• Format: Article
• Language: English
• Subjects: Alzheimer's disease dementia; Comorbidities; Discover dataset; Healthcare use and cost; Social care
• ISSN: 2667-0321; 2667-0321
• DOI: 10.1016/j.ahr.2024.100180

•High-cost AD dementia subpopulations cost 1.32 to 1.66 times the average (£4548).•For the 48 % who used social care, healthcare costs were £5433per person year (ppy) and social care costs £24,374ppy.•Dying during follow up, frailty and having had a stroke were associated with high costs.•Characteristics of individuals with high healthcare costs include requirement for social care and cardiometabolic comorbidities. Evidence on health and social care resource utilisation and associated costs, and how this varies across people with Alzheimer's disease (AD) dementia is limited. Retrospective cohort, using the Discover dataset, which includes linked health and social care records for approximately 2.5 million people in North-West London. Individuals were followed up from the latter of 2010 or from diagnosis of AD dementia (index) up to 2019. Outcomes were overall survival, care home admission, health and social care utilisation and associated costs, and cardiovascular outcomes. Variation was explored in subpopulations and by stratifying by cost quintile. Generalised linear modelling was used to estimate the association between clinical and demographic characteristics and healthcare costs. The cohort included 18,116 people diagnosed with AD dementia whose mean age at index was 81 years, 62 % were female and 65 % were of white ethnicity. Median survival from index was 4.9 years (95 %CI: 4.8–5.0). Mean healthcare costs were £4,548(£4,491–£4,604) per person year(ppy). Healthcare costs for the 48 % who used social care were £5,433ppy(£5,353–£5,514) and social care costs were £24,374ppy(£24,372–£24,376). In the overall cohort costs in the highest cost quintile were £13,665ppy(£13,420–£13,911), of which 70 % was from inpatient hospitalisation. Subpopulations admitted to care home (£7,535 £7,362–£7,709), with cardiovascular disease (£6,106;£5,990–£6,222) and with type 2 diabetes (£6,049;£5,901–£6,198) accrued the highest healthcare costs. Factors most strongly associated with cost were dying during follow up (+£2,224;£2,010–£2,493), being frail (+£1,246;£1,051–£1,440) and prior stroke (+£1,207;£908–£1,507). Characteristics of individuals with high healthcare costs include requirement for social care and cardiometabolic comorbidities. Identifying individuals early in their disease course may improve health outcomes and reduce the cost of AD dementia in later life.