Out‐of‐pocket costs attributable to dementia: A longitudinal analysis
Open accessAbstract
Background: Alzheimer's disease and related dementias (ADRD) affect 5.7 million Americans, and are expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, even though one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare. Methods: In this paper, we use survey data for 2002–2016 from the Health and Retirement Study to estimate the out‐of‐pocket costs of ADRD for the patient and their family through the first 8 years after the onset of symptoms, as defined by a standardized 27‐point scale of cognitive ability. A two‐part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization. Results: We identified a cohort of 3619 incident dementia cases, 38.9% were male, and 66.9% were non‐Hispanic White. Dementia onset was 77.7 years of age, on average. OOP costs attributable to dementia are $8751 over the first 8 years after the onset. These incremental costs are driven by nursing home expenditures, which are largely uninsured in the US. OOP spending is highest for whites and women. Conclusion: The financial burden of ADRD is significant, and largely attributable to the lack of wide‐spread long‐term care insurance.
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Out-of-pocket costs for Alzheimer's and other dementias have been shown to increase over time, from $3,104 in the first two years after diagnosis to $3,730 in years three to four, to $3,934 in years seven to eight (2017 dollars; $3,579, $4,300, and $4,535 in 2023 dollars).
“Although incremental Medicare expenditures peak in the year after diagnosis and decrease in the subsequent four years, out‐of‐pocket costs have been shown to increase over time, from $3,104 in the first two years after diagnosis to $3,730 in years three to four after diagnosis, to $3,934 in years seven to eight after diagnosis (in 2017 dollars; $3,579, $4,300 and $4,535 in 2023 dollars). 865”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [865]
The Results report that out-of-pocket spending for people with dementia fell from $7,506 in the first two years after symptom onset to $3,630 in years seven and eight. The Discussion likewise says costs were highest around symptom onset and declined thereafter. The cited paper does not support the claimed increase or its dollar figures; it measures time from symptom onset, not diagnosis. (LLM, conf=0.92)
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Research works printed but not linked: 1
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2024 Alzheimer's disease facts and figures
(2024) · Alzheimer's & Dementia · doi:10.1002/alz.13809 · Cited by 2,536 · see citing works
- Authors
- Oney, M., White, L., & Coe, N. B.
- Affiliations
- University of Pennsylvania (US)
- RTI International (US)
- Leonard Davis Institute of Health Economics (US)
- Corresponding author
- Oney, Melissa
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2022-03-12
- Volume
- 70
- Issue
- 5
- Pages
- 1538-1545
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC9106861
- OpenAlex
- W4221023005
- Cited by
- 29
- References
- 25
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 7 · 2023: 6 · 2022: 1
- FWCI
- 4.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG049815)
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- Alzheimer's disease and related dementias, dementia, out-of-pocket costs, financial burden, long-term care insurance, Medicare, health care utilization, longevity, Health and Retirement Study
- MeSH terms
- Aged, Alzheimer Disease, Ethnicity, Health Expenditures, Female, Medicare, Humans, Male, Nursing Homes, United States
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