title: Estimating the relationship between disease progression and cost of care in dementia.
abstract: BACKGROUND
  Previous studies have shown a positive relationship between disease severity and cost.
  
  
  OBJECTIVE
  To explore the factors affecting time to institutionalisation and estimate the relationship between the costs of care and disease progression.
  
  
  METHODS
  Retrospective analysis of a longitudinal data-set for a cohort of 100 patients diagnosed with Alzheimer's disease or vascular dementia.
  
  
  RESULTS
  Changes in both Mini-Mental State Examination (MMSE) and Barthel scores have independent and significant marginal effects on costs. Each one-point decline in the MMSE score is associated with a pound sterling 56 increase in the four-monthly costs, whereas each one-point fall in the Barthel index is associated with a pound sterling 586 increase in costs.
  
  
  CONCLUSIONS
  It may be inappropriate for economic models of disease progression in dementia to be based solely on measures of cognitive change. MMSE and the Barthel index are independent significant predictors of time to institutionalisation and cost of care, but changes in the Barthel index are particularly important in predicting costs outside institutional care.
authors.affiliation: Health Economics Research Centre, University of Oxford, Headington, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wolstenholme
authors.forename: P
authors.initials: P
authors.lastname: Fenn
authors.forename: A
authors.initials: A
authors.lastname: Gray
authors.forename: J
authors.initials: J
authors.lastname: Keene
authors.forename: R
authors.initials: R
authors.lastname: Jacoby
authors.forename: T
authors.initials: T
authors.lastname: Hope
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003704:Dementia / Q000191:economics* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics*; D006801:Humans; D007326:Institutionalization / Q000191:economics; D008137:Longitudinal Studies; D008297:Male; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors