Thomas Rapp

Exploring the Relationship between Alzheimer's Disease Severity and Longitudinal Costs

OBJECTIVE The joint impact of cognitive, functional, and behavioral statuses must be measured when exploring the impact of new drugs on Alzheimers disease (AD) costs. There are very few recent studies of AD costs by all dimensions of disease severity. Our objective was to improve estimation of the relationship between AD severity and costs of AD care by using more comprehensive AD data severity and a large sample size. METHODS Participants were community-dwelling AD patients recruited between 2003 and 2005 and followed annually during a 2-year period in 50 French memory clinics. We used the Resource Use in Dementia questionnaire to estimate costs from a societal perspective. We explored the presence of potential endogeneity bias by using instrumental variable regressions. RESULTS Cognitive declines impacted informal costs more than medical and nonmedical costs, while functional declines impacted nonmedical costs more than medical and informal costs. Both cognitive and function declines increased the total costs of care. We found that the endogeneity of these variables led to a large underestimation of their impact of AD severity on costs. CONCLUSION Potential endogeneity should be controlled for to prevent biased estimations of the impact of AD severity measures on costs.

Methodological considerations in cost of illness studies on Alzheimer disease

Cost-of-illness studies (COI) can identify and measure all the costs of a particular disease, including the direct, indirect and intangible dimensions. They are intended to provide estimates about the economic impact of costly disease. Alzheimer disease (AD) is a relevant example to review cost of illness studies because of its costliness.The aim of this study was to review relevant published cost studies of AD to analyze the method used and to identify which dimension had to be improved from a methodological perspective. First, we described the key points of cost study methodology. Secondly, cost studies relating to AD were systematically reviewed, focussing on an analysis of the different methods used. The methodological choices of the studies were analysed using an analytical grid which contains the main methodological items of COI studies. Seventeen articles were retained. Depending on the studies, annual total costs per patient vary from

Comparison of Informal Care Time and Costs in Different Age-Related Dementias: A Review

2,935 to

Trends in Disparities in Receipt of Adjuvant Therapy for Elderly Stage Iii Colon Cancer Patients: The Role of the Medical Oncologist Evaluation

52, 954. The methods, data sources, and estimated cost categories in each study varied widely. The review showed that cost studies adopted different approaches to estimate costs of AD, reflecting a lack of consensus on the methodology of cost studies. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable.

Public financial support receipt and non-medical resource utilization in Alzheimer's disease results from the PLASA study

Objectives. Age-related dementia is a progressive degenerative brain syndrome whose prevalence increases with age. Dementias cause a substantial burden on society and on families who provide informal care. This study aims to review the relevant papers to compare informal care time and costs in different dementias. Methods. A bibliographic search was performed on an international medical literature database (MEDLINE). All studies which assessed the social economic burden of different dementias were selected. Informal care time and costs were analyzed in three care settings by disease stages. Results. 21 studies met our criteria. Mean informal care time was 55.73 h per week for Alzheimer disease and 15.8 h per week for Parkinson disease (P = 0.0076), and the associated mean annual informal costs were

Cost-effectiveness of a Motivational Intervention to Reduce Rapid Repeated Childbearing in High-Risk Adolescent Mothers A Rebirth of Economic and Policy Considerations

17,492 versus

Patients' diagnosis decisions in Alzheimer's disease: The influence of family factors

3,284, respectively (P = 0.0393). Conclusion. There is a lack of data about informal care time and costs among other dementias than AD or PD. Globally, AD is the most costly in terms of informal care costs than PD,

Are public subsidies effective to reduce emergency care? Evidence from the PLASA study

17,492 versus

Preventing mobility disability in Europe: a health economics perspective from the SPRINTT study

3,284, respectively.

Exploring the determinants of endocrinologist visits by patients with diabetes

Background:Race disparities in adjuvant chemotherapy for stage III colon cancer patients have been documented, and medical oncologist evaluation is a critical step in the treatment process. Recent healthcare system and environmental changes may have reduced treatment gaps. Objectives:To examine differential rates of oncologist evaluation and conditional treatment, by race, and to determine whether changing evaluation and treatment patterns reduced disparities. Research Design:Retrospective analysis of Surveillance Epidemiology and End Results-Medicare registry, enrollment, and claims data. Subjects:Patients age >65, white or African American race, diagnosed with American Joint Committee on Cancer stage III colon cancer between 1997 and 2002. N = 7176. Key Measures:Oncology specialty evaluation and management visit or chemotherapy claim; receipt of 5-fluorouracil based chemotherapy. Time periods are grouped into early (1997–1998), middle (1999–2000), and late (2001–2002). Results:Initial adjusted oncologist evaluation rates were higher for whites compared with African American patients (58.7% vs. 42.9%), but changes over time reduced the race gap substantially. We did not find significant race-time trends in treatment rates conditional on oncologist evaluation. Conclusions:Race disparities in medical oncologist evaluations diminished over time, possibly in response to increased provider supply or changing patient and provider attitudes, but there was no parallel reduction in disparities in conditional treatment rates. Projected decreases in oncologist supply suggest the need for further research on this relationship. Research on the role of supplemental medical insurance on disparities in treatment is needed, particularly as the cost of recommended adjuvant therapy increases.