Primary care expenditures before the onset of Alzheimer's disease.
OBJECTIVE
To investigate primary care expenditures in the period before diagnosis of AD.


METHODS
In a population-based sample of Medicare enrollees in New York City, person-level 1996 Medicare claims, summed over primary care encounters, were examined for people who developed AD in 1997 to 1998 and those who did not.


RESULTS
People who developed AD were more likely to use Medicare outpatient and ambulatory care 1 to 2 years before diagnosis. Compared with respondents who did not develop AD, the excess cost for men was $1,167 (85% higher) and for women $239 (26% higher). Among elderly people > or = 75 years in the United States, the prodromal period of AD was associated with an excess Medicare-based primary care cost of $128.5 to $194.7 million.


CONCLUSIONS
In addition to huge costs associated with AD after diagnosis, prediagnosis costs are an unrecognized source of expenditures related to the disease.
Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY 10032, USA. sma10@columbia.edu
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Albert
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D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000191:economics* / Q000208:ethnology; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D003072:Cognition Disorders / Q000191:economics* / Q000208:ethnology; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data*; D009519:New York City / Q000453:epidemiology; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D017678:Sex Distribution; D014481:United States; D044465:White People / Q000706:statistics & numerical data