Research Center for Social Science and Medicine Tokyo Metropolitan. Institute of Medical Science, Tokyo, Japan.
Department of Health Economics and Outcomes Research Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.
Curr Med Res Opin. 2021 Aug;37(8):1331-1339. doi: 10.1080/03007995.2021.1922369. Epub 2021 May 20.
To determine the longitudinal societal costs and burden of community-dwelling patients with Alzheimer's disease (AD) and their caregivers in Japan.
GERAS-J was an 18-month, prospective, longitudinal, observational study. Using the Mini-Mental State Examination (MMSE), patients routinely visiting memory clinics were stratified into groups based on AD severity at baseline (mild, moderate, and moderately severe/severe [MS/S]). Healthcare resource utilization and caregiver burden were assessed using the Resource Utilization in Dementia and Zarit "Caregiver" Burden Interview questionnaires, respectively. Total monthly societal costs were estimated using Japan-specific unit costs of services and products (patient direct healthcare use, patient social care use, and informal caregiving time).
Overall, 553 patients (156 mild; 209 moderate; 188 MS/S) were enrolled. MMSE scores declined (1.73, 1.38, and 0.95 points for the mild, moderate, and MS/S AD groups, respectively) and caregiver burden and resource utilization increased over 18 months in each of the AD severity groups. Cumulative total societal costs per patient over 18 months were 3.1, 3.8, and 5.3 million Japanese yen (29,006, 35,662, and 49,725 USD) for mild, moderate, and MS/S AD, respectively. Both patient social care costs and caregiver informal care costs increased with baseline disease severity, with >50% of total costs due to caregiver informal care in each disease severity subgroup.
Total treatment costs increased with AD severity over 18 months due to increases in both patient social care costs and caregiver informal care costs. Our data suggest current social care services in Japan are insufficient to alleviate the negative impact of AD on caregiver burden.
确定日本社区居住的阿尔茨海默病（AD）患者及其照料者的纵向社会成本和负担。
GERAS-J 是一项为期 18 个月的前瞻性纵向观察研究。使用简易精神状态检查（MMSE），根据基线时 AD 的严重程度（轻度、中度和中重度/重度[MS/S]）将经常到记忆诊所就诊的患者分为不同组。使用资源利用在痴呆症和 Zarit“照顾者”负担访谈问卷分别评估医疗资源利用和照顾者负担。使用特定于日本的服务和产品的单位成本（患者直接医疗保健使用、患者社会护理使用和非正式护理时间）来估算每月总社会成本。
总体而言，共纳入 553 名患者（轻度 156 名，中度 209 名，MS/S 188 名）。在每个 AD 严重程度组中，MMSE 评分下降（轻度、中度和 MS/S AD 组分别为 1.73、1.38 和 0.95 分），并且在 18 个月内照顾者负担和资源利用增加。在 18 个月内，每位患者的累计总社会成本分别为 310 万日元（29006 美元）、380 万日元（35662 美元）和 530 万日元（49725 美元）用于轻度、中度和 MS/S AD。患者社会护理成本和照顾者非正式护理成本均随基线疾病严重程度而增加，每个疾病严重程度亚组中超过 50%的总费用归因于照顾者非正式护理。
由于患者社会护理成本和照顾者非正式护理成本的增加，18 个月内 AD 严重程度的总治疗成本增加。我们的数据表明，日本当前的社会护理服务不足以缓解 AD 对照顾者负担的负面影响。
