Fundació Hospital de Palamós - Serveis de Salut Integrats Baix Empordà(SSIBE), Palamós, Spain.
Health services and health outcomes research group (GRESSIRES), Serveis de Salut Integrats Baix Empordà, Palamós, Spain.
J Alzheimers Dis. 2023;95(1):131-147. doi: 10.3233/JAD-221220.
The large number of dementia cases produces a great pressure on health and social care services, which requires efficient planning to meet the needs of patients through infrastructure, equipment, and financial, technical, and personal resources adjusted to their demands. Dementia analysis requires studies with a very precise patient characterization of both the disease and comorbidities present, and long-term follow-up of patients in clinical aspects and patterns of resource utilization and costs generated.
To describe and quantify direct healthcare expenditure and its evolution from three years before and up to ten years after the diagnosis of dementia, compared to a matched group without dementia.
Retrospective cohort design with follow-up from 6 to 14 years. We studied 996 people with dementia (PwD) and 2,998 controls matched for age, sex, and comorbidity. This paper adopts the provider's perspective as the perspective of analysis and refers to the costs actually incurred in providing the services. Aggregate costs and components per patient per year were calculated and modelled.
Total health expenditure increases in PwD from the year of diagnosis and in each of the following 7 years, but not thereafter. Health status and mortality are factors explaining the evolution of direct costs. Dementia alone is not a statistically significant factor in explaining differences between groups.
The incremental direct cost of dementia may not be as high or as long as studies with relatively short follow-up suggest. Dementia would have an impact on increasing disease burden and mortality.
大量的痴呆病例给卫生和社会保健服务带来了巨大压力，这需要通过基础设施、设备以及调整后的财务、技术和人员资源来进行有效的规划，以满足患者的需求。痴呆症分析需要对患者的疾病和并存疾病进行非常精确的特征描述，并对患者的临床方面以及资源利用和产生的成本模式进行长期随访。
描述并量化痴呆症诊断前三年和诊断后十年内直接医疗保健支出及其变化情况，并与无痴呆症的对照组进行比较。
回顾性队列设计，随访时间为 6 至 14 年。我们研究了 996 名痴呆症患者（PwD）和 2998 名年龄、性别和合并症相匹配的对照组。本研究采用提供者的角度作为分析角度，指的是提供服务实际发生的成本。计算并建模了每个患者每年的总费用和各部分费用。
PwD 的总医疗支出从诊断当年及随后的 7 年每年都在增加，但之后不再增加。健康状况和死亡率是解释直接成本变化的因素。痴呆症本身并不是导致组间差异的统计学显著因素。
痴呆症的增量直接成本可能不像随访时间相对较短的研究所表明的那么高或持续时间那么长。痴呆症会对增加疾病负担和死亡率产生影响。
