[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 4, November 2011].
Estimates of the future cost of dementia care in Australia have typically been based on disease prevalence and the average cost per patient over the duration of illness. The authors of this study point out that dementia care costs vary according to the length of the disease, the severity of symptoms and type of care provided. They demonstrate that taking these factors into consideration helps to determine the future costs of dementia management more accurately.
The prevalence of dementia in Australia (2010-2040) is estimated, and the authors investigate the data on disease prevalence according to underlying factors: (1) the location (home / institution), (2) care requirements (informal/formal), and (3) dementia severity. The costs of care are then used to predict the future costs of dementia. Computer modeling indicates that the ratio between the prevalence of people with mild / moderate / severe dementia will change over the three decades from 2010 to 2040 from 50 / 30 / 20 to 44 / 32 / 24.
Based on figures for the severity of symptoms, the location of care and the cost of care per hour, this study estimates that the informal cost of care in 2010 is AU$3.2 billion and formal care is AU$5.0 billion per annum.
By 2040 informal care is projected to cost AU$11.6 billion and formal care $AU16.7 billion per annum.
“ …both prevalence and cost of care increase over time, [but] an intervention to delay disease progression by 2 years will increase prevalence and reduce overall care costs over time. On the other hand, an intervention to delay disease onset by 2 years will reduce both prevalence and overall care costs over time” (p.9).
Interventions to slow disease progression could result in relative savings of 5% (AU$1.5 billion) per annum and interventions to delay disease onset could result in relative savings of 14% (AU$4 billion) of the cost per annum.
Without intervention, the projected combined annual cost of formal and informal care for each person with dementia in 2040 could be an estimated AU$38,000 (in 2010 dollars). Interventions to delay progression by 2 years reduce this to AU$35,000 per person.
The authors remind us that there is more than total prevalence data to be considered when estimating the costs of dementia care. Dynamic systems modeling is needed to explore the alternatives and for the estimation of future trends.
The potential of interventions to prolong disease progression, or to delay disease onset, to yield savings in terms of prevalence, or cost of care, or both, is not the end of the debate. In practice, these potential savings are not necessarily going to be passed on to individuals. Clinicians and policy makers need to consider who pays, and who benefits from interventions.
Vickland, V. Werner, J. [and] Morris, T. [et al] (2011). Who pays and who benefits? How different models of shared responsibilities between formal and informal carers influence projections of costs of dementia management. BMC Public Health, 2011. (Click here to view the PubMed abstract).