Eli Lilly and Company, Indianapolis, IN, USA.
Harvard Medical School, Boston, MA, USA.
J Alzheimers Dis. 2020;75(2):437-450. doi: 10.3233/JAD-191212.
Costs associated with early stages of Alzheimer's disease (AD; mild cognitive impairment [MCI] and mild dementia [MILD]) are understudied.
To compare costs associated with MCI and MILD due to AD in the United States.
Data included baseline patient/study partner medical history, healthcare resource utilization, and outcome assessments as part of a prospective cohort study. Direct, indirect, and total societal costs were derived by applying standardized unit costs to resources for the 1-month pre-baseline period (USD2017). Costs/month for MCI and MILD cohorts were compared using analysis of variance models. To strengthen the confidence of diagnosis, amyloid-β (Aβ) tests were included and analyses were replicated stratifying within each cohort by amyloid status [+ /-].
Patients (N = 1327) with MILD versus MCI had higher total societal costs/month ($4243 versus $2816; p < 0.001). These costs were not significantly different within each severity cohort by amyloid status. The largest fraction of overall costs were informal caregiver costs (45.1%) for the MILD cohort, whereas direct medical patient costs were the largest for the MCI cohort (39.0%). Correspondingly, caregiver time spent on basic activities of daily living (ADLs), instrumental ADLs, and supervision time was twice as high for MILD versus MCI (all p < 0.001).
Early AD poses a financial burden, and despite higher functioning among those with MCI, caregivers were significantly impacted. The major cost driver was the patient's clinical cognitive-functional status and not amyloid status. Differences were primarily due to rising need for caregiver support.
与阿尔茨海默病（AD；轻度认知障碍[MCI]和轻度痴呆[MILD]）早期阶段相关的成本研究较少。
比较美国 AD 导致的 MCI 和 MILD 相关成本。
数据包括基线患者/研究伙伴的病史、医疗资源利用情况和结果评估，作为前瞻性队列研究的一部分。直接、间接和总社会成本通过将资源的标准化单位成本应用于 1 个月的基线前期间（2017 年美元）得出。使用方差分析模型比较 MCI 和 MILD 队列的每月成本。为了加强诊断的可信度，纳入了淀粉样蛋白-β（Aβ）测试，并在每个队列内按淀粉样蛋白状态[+/-]进行分层复制分析。
MILD 患者与 MCI 患者相比，每月总社会成本更高（$4243 与 $2816；p<0.001）。在每个严重程度队列内，根据淀粉样蛋白状态，这些成本没有显著差异。整体成本的最大部分是 MILD 队列的非正规护理者成本（45.1%），而 MCI 队列的直接医疗患者成本最大（39.0%）。相应地，MILD 患者花费在基本日常生活活动（ADL）、工具性 ADL 和监督上的护理时间是 MCI 的两倍（均 p<0.001）。
早期 AD 带来经济负担，尽管 MCI 患者的功能较高，但护理者受到了显著影响。主要成本驱动因素是患者的临床认知功能状况，而不是淀粉样蛋白状态。差异主要是由于对护理者支持的需求增加所致。
