社区居住老年人痴呆症和认知障碍的增量医疗保健成本：一项前瞻性队列研究。
Incremental Healthcare Costs of Dementia and Cognitive Impairment in Community-Dwelling Older Adults: A Prospective Cohort Study.
作者信息
Sheets Kerry M, Fink Howard A, Langsetmo Lisa, Kats Allyson M, Schousboe John T, Yaffe Kristine, Ensrud Kristine E
机构信息
Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA.
Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
出版信息
J Gerontol A Biol Sci Med Sci. 2025 Apr 7;80(5). doi: 10.1093/gerona/glaf030.
BACKGROUND
Cognitive impairment and dementia are associated with higher healthcare costs; whether these increased costs are attributable to a greater comorbidity burden is unknown. We sought to determine associations of cognitive impairment and dementia with subsequent total and sector-specific healthcare costs after accounting for comorbidities and to compare costs by method of case ascertainment.
METHODS
Index examinations (2002-2011) of 4 prospective cohort studies linked with Medicare claims. 8 165 community-dwelling Medicare fee-for-service beneficiaries (4 318 women; 3 847 men). Cognitive impairment identified by self-or-proxy report of dementia and/or abnormal cognitive testing. Claims-based dementia and comorbidities derived from claims using Chronic Condition Warehouse algorithms. Annualized healthcare costs (2023 dollars) were ascertained for 36 months following index examinations.
RESULTS
521 women (12.1%) and 418 men (10.9%) met the criteria for cognitive impairment; 388 women (9%) and 234 men (6.1%) met the criteria for claims-based dementia. After accounting for age, race, geographic region, and comorbidities, mean incremental costs of cognitive impairment versus no cognitive impairment in women (men) were $6 883 ($7 276) for total healthcare costs, $4 160 ($4 047) for inpatient costs, $1 206 ($1 587) for skilled nursing facility (SNF) costs, and $689 ($668) for home healthcare (HHC) costs. Mean adjusted incremental total and inpatient costs associated with claims-based dementia were smaller in magnitude and not statistically significant. Mean adjusted incremental costs of claims-based dementia versus no claims-based dementia in women (men) were $759 ($1 251) for SNF costs and $582 ($535) for HHC costs.
CONCLUSIONS
Cognitive impairment is independently associated with substantial incremental total and sector-specific healthcare expenditures not fully captured by claims-based dementia or comorbidity burden.
背景
认知障碍和痴呆与更高的医疗费用相关；这些增加的费用是否归因于更大的合并症负担尚不清楚。我们试图确定在考虑合并症后认知障碍和痴呆与随后的总医疗费用及特定部门医疗费用之间的关联，并通过病例确定方法比较费用。
方法
对4项前瞻性队列研究的索引检查（2002 - 2011年）与医疗保险索赔相关联。8165名社区居住的医疗保险按服务收费受益人（4318名女性；3847名男性）。通过自我或代理人报告的痴呆和/或异常认知测试确定认知障碍。基于索赔的痴呆和合并症使用慢性病仓库算法从索赔中得出。在索引检查后的36个月内确定年化医疗费用（2023美元）。
结果
521名女性（12.1%）和418名男性（10.9%）符合认知障碍标准；388名女性（9%）和234名男性（6.1%）符合基于索赔的痴呆标准。在考虑年龄、种族、地理区域和合并症后，女性（男性）认知障碍与无认知障碍相比，总医疗费用的平均增量成本为6883美元（7276美元），住院费用为4160美元（4047美元），熟练护理机构（SNF）费用为1206美元（1587美元），家庭医疗保健（HHC）费用为689美元（668美元）。与基于索赔的痴呆相关的平均调整后增量总费用和住院费用在幅度上较小且无统计学意义。女性（男性）基于索赔的痴呆与无基于索赔的痴呆相比，SNF费用的平均调整后增量成本为759美元（1251美元），HHC费用为582美元（535美元）。
结论
认知障碍与大量的增量总医疗费用和特定部门医疗费用独立相关，基于索赔的痴呆或合并症负担并未完全体现这些费用。
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