Department of Gerontology and Gerontology Institute, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, USA.
Curr Alzheimer Res. 2010 Jun;7(4):348-57. doi: 10.2174/156720510791162386.
To examine the relationship between multiple measures of health care costs and health utilities, quality of life, and other factors in Alzheimer's Disease (AD).
Data were obtained via caregiver proxy at baseline and 3- 6- and 9-months following study entry on 421 patients with AD who participated in the CATIE-AD trial of antipsychotic medication. Spearman rank correlations and mixed models (using logged costs) were used to examine the correlates of health care costs.
Health care costs include inpatient hospital, nursing home, residential care, combined institutional, outpatient, ancillary drug, and total costs. Correlates include the AD-Related Quality of Life Scale (ADRQoL) and Health Utilities Index (HUI)-III.
Total monthly health care costs averaged $1,205 during the study period. Each .10 increment on the HUI-III (stronger health utilities) was associated with a decrease in institutional, outpatient, and total costs of 9.7%, 6.9%, and 8.2%, respectively. Each one-point increase on the ADRQoL (better quality of life) was associated with an increase in ancillary drug and total costs of 1.7% and 2.1%. Total costs tended to be lower for female patients (beta=-.325) with better physical functioning (beta=-.017) but higher for less cognitively impaired individuals (beta=.038). Older (beta=.025), non-Hispanic Whites (beta=.575) tended have higher outpatient costs, those with better physical functioning lower institutional costs (beta=-.019). Drug costs tended to be lower for females (beta=-.427) and higher for those with greater psychiatric symptoms (beta=.016).
The HUI-III findings suggest that health utilities could be combined with other known correlates of costs to inform resource allocation cost-effectiveness analyses associated with AD. The ADRQoL findings suggest that better quality of life may make it easier for caregivers to identify problems and/or to access and maintain certain types of health system contacts.
探讨多种医疗成本衡量指标与阿尔茨海默病（AD）患者健康效用值、生活质量及其他因素之间的关系。
数据来源于 CATIE-AD 抗精神病药物试验中 421 名 AD 患者的照顾者代理，在研究入组后 3、6 和 9 个月时，通过患者代理收集基线数据。采用 Spearman 秩相关和混合模型（采用对数成本）分析医疗成本的相关因素。
医疗成本包括住院、疗养院、护理院、联合机构、门诊、辅助药物和总费用。相关因素包括 AD 相关生活质量量表（ADRQoL）和健康效用指数（HUI）-III。
研究期间，患者每月平均总医疗费用为 1205 美元。HUI-III 每增加 0.10（健康效用越强），机构、门诊和总费用分别降低 9.7%、6.9%和 8.2%。ADRQoL 每增加 1 分（生活质量越好），辅助药物和总费用分别增加 1.7%和 2.1%。女性患者（β=-.325）总费用较低，身体功能较好（β=-.017），认知功能损害较轻（β=.038）的患者总费用较高。年龄较大（β=.025）、非西班牙裔白人（β=.575）患者门诊费用较高，身体功能较好的患者机构费用较低（β=-.019）。女性患者（β=-.427）药物费用较低，精神症状较重的患者（β=.016）药物费用较高。
HUI-III 的研究结果表明，健康效用值可以与其他已知成本相关因素相结合，用于为 AD 相关资源配置的成本效益分析提供信息。ADRQoL 的研究结果表明，生活质量较高可能使照顾者更容易发现问题，或更容易获得和维持某些类型的医疗系统联系。
