Date Published: August 22, 2017
Publisher: BioMed Central
Author(s): Bernhard Michalowsky, Steffen Flessa, Johannes Hertel, Olav Goetz, Wolfgang Hoffmann, Stefan Teipel, Ingo Kilimann.
Little is known about diagnostic work-ups or the costs of diagnosing dementia in specialized care. Here, we analyzed the costs of diagnosing dementia according to specific dementia disorders.
A prospective descriptive design was used to analyze the cost of diagnosing dementia for 120 patients with suspected dementia at a German memory clinic. The duration of clinical consultations and use of technical procedures were recorded by the memory clinic staff. To detect cost drivers, a multiple linear regression model was used.
Of patients with suspected dementia, 44% were diagnosed with dementia. The total cost per patient and diagnostic process amounted to 501 € across all patients and 659 € for patients who were diagnosed with dementia. The costs varied between 649 € for patients with Alzheimer’s disease, 662 € for patients with vascular or mixed dementia, and 705 € for patients with unspecific dementia. A final diagnosis of dementia was the only factor that was significantly associated with the diagnostic cost (b = 356, CI– 182, CI+ 531, p = 0.001).
The high range of costs reflects differences in diagnostic demands depending on the etiology of dementia. This variation needs to be transferred into reimbursement. Further studies are needed to assess the influence of the type of cognitive impairment and of the setting on diagnostic costs.
The online version of this article (doi:10.1186/s13195-017-0290-6) contains supplementary material, which is available to authorized users.
The syndrome of dementia is characterized by a loss of memory and other mental abilities that are severe enough to interfere with daily life . Most often, dementia is caused by a chronic and progressive neurodegenerative disease, usually Alzheimer’s disease. Worldwide, there are more than 46.8 million persons living with dementia. This number is expected to double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050 [2–4]. In Germany, the current number of persons with dementia is estimated to be over 1.6 million, with an annual incidence of over 300,000 new cases . From an economic point of view, dementia is the main cause of long-term institutional care in the older population and is therefore associated with substantial healthcare costs . Specifically, the total worldwide cost of dementia was estimated at 784 billion € (US$ 818 billion; 1 € = US$ 1.043, exchange rate as of 16 December 2016) in 2016. Thus, dementia is one of the most expensive diseases in old age [2, 7].
This study demonstrates the costs of diagnosing different dementia disorders for patients with suspected dementia in a specialized memory clinic on the basis of assessed time-related clinical consultations and the specific technical procedures used to identify relevant biomarkers. The total cost per patient and process was 501 €, and was 659 € for patients who were diagnosed with dementia. The cost of diagnosing different dementia disorders varied between 649 € for patients diagnosed with Alzheimer’s disease and 705 € for patients diagnosed with unspecific dementia. The cost of a true dementia case (nondementia case) was 1134 € (897 €).
The cost of diagnosing different dementia disorders varied between 649 € for patients diagnosed with Alzheimer’s disease and 705 € for patients diagnosed with unspecific dementia, representing solely a small percentage of diagnostic costs among total expenditures on dementia diseases. However, the currently unstandardized financing structures of memory clinics differ tremendously and thus represent a risk for such diagnostic facilities. Designing a reimbursement system that aligns the incentives of physicians, patients, and the public payer could be very difficult but is of vital importance to expand the use of biomarkers in the diagnostic procedure on a routine base. However, evidence concerning the cost for diagnosing specific dementia diseases in different settings is actually missing. It would be in patients’ interest to support an adequate and comprehensive diagnostic process creating the foundation for adequate treatment, without leading to economic inefficiency that could jeopardize the sustainability of a memory clinic or practices in primary care. Therefore, more studies are needed to gather more information regarding diagnostic processes in dementia and regarding the cost of diagnosing dementia. Therefore, it is of high interest to assess the cost of diagnosing dementia in a larger multicenter sample of patients with suspected dementia, especially in different countries, healthcare systems, and healthcare settings.