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For LS, PMe, RL, RH (Helmholtz Zentrum München), and EG (University Hospital Erlangen - Clinic for Psychiatry and Psychotherapy) their institution received support from the funding organisations for the submitted work. SW (AOK Bavaria), HM (Eisai GmbH) and PMa (Pfizer Deutschland GmbH), are employees of one of the funding organisations and received a regular salary while contributing to the work; RL and EG received a honorarium from one of the funding organizations for presenting data or participating in an advisory board.
LS analysed the data and wrote the manuscript. PMe developed the statistical models and revised the statistics section of the manuscript. Together with RH, both decided on study design and the research questions to be answered. RL, SW, HM, PMa and EG advised on health care system-related issues and were involved in the constitution of the final study design. All authors contributed to the manuscript and approved the final version of the manuscript. RH is guarantor.
Demographic ageing is associated with an increasing number of dementia patients, who reportedly incur higher costs of care than individuals without dementia. Regarding Germany, evidence on these excess costs is scarce. Adopting a payer perspective, our study aimed to quantify the additional yearly expenditures per dementia patient for various health and long-term care services. Additionally, we sought to identify gender-specific cost patterns and to describe age-dependent cost profiles.
The analyses used 2006 claims data from the AOK Bavaria Statutory Health Insurance fund of 9,147 dementia patients and 29,741 age- and gender-matched control subjects. Cost predictions based on two-part regression models adjusted for age and gender and excess costs of dementia care refer to the difference in model-estimated means between both groups. Corresponding analyses were performed stratified for gender. Finally, a potentially non-linear association between age and costs was investigated within a generalized additive model.
Yearly spending within the social security system was circa €12,300 per dementia patient and circa €4,000 per non-demented control subject. About two-thirds of the additional expenditure for dementia patients occurred in the long-term care sector. Within our study sample, male and female dementia patients incurred comparable total costs. However, women accounted for significantly lower health and significantly higher long-term care expenditures. Long-term care spending increased in older age, whereupon health care spending decreased. Thus, at more advanced ages, women incurred greater costs than men of the same age.
Dementia poses a substantial additional burden to the German social security system, with the long-term care sector being more seriously challenged than the health care sector. Our results suggest that female dementia patients need to be seen as a key target group for health services research in an ageing society. It seems clear that strategies enabling community-based care for this vulnerable population might contribute to lowering the financial burden caused by dementia. This would allow for the sustaining of comprehensive dementia care within the social security system.