title: Patterns of healthcare utilization and costs for vascular dementia in a community-dwelling population.
abstract: BACKGROUND
  While vascular dementia (VaD) is the second most prevalent dementia diagnosis, little is known about healthcare use and costs for VaD.
  
  
  OBJECTIVE
  This study compares the healthcare use and costs of community-dwelling patients with VaD to patients with Alzheimer's disease (AD), other dementias (OD), cerebrovascular disease without dementia (CVD), and patients without dementia or cerebrovascular disease (controls).
  
  
  METHODS
  Using diagnoses codes from medical claims and encounter records, 678 VaD, 1,722 AD, 957 OD, 2,718 CVD, and 14,023 controls were identified from patients enrolled in a 100,000-member group practice Medicare HMO during 1999-2002. Annual healthcare use and costs of the study groups were compared, using regression analysis to control for patient characteristics.
  
  
  RESULTS
  VaD patients had the highest annual costs, dollars 14,387, followed by dollars 10,716 for OD, dollars 8,254 for CVD, and dollars 7,839 for AD, and dollars 5,494 for controls (p<0.0001 for all comparisons to VaD). Despite higher total direct costs, VaD patients had lower costs for physician visits and prescription drugs compared with all study groups except OD. In contrast, CVD patients had the highest costs for these services. Moreover, hospital admissions for VaD were nearly twice those for CVD, and hospital days for VaD nearly three times those for CVD, despite the high prevalence of cardiovascular conditions for both VaD and CVD.
  
  
  CONCLUSIONS
  VaD patients had higher healthcare costs compared to all other patient groups. The substantially higher costs for VaD compared to CVD and the differences in use of healthcare services by VaD compared to CVD suggest that dementia, not cerebrovascular disease, is a major source of the cost differences. Lower costs for physician visits and prescription drugs for VaD suggest possible opportunities for improving ambulatory care and preventing high-cost hospitalizations.
authors.affiliation: Institute for the Study of Aging, New York, NY 10019, USA. jhill@aging-institute.org
authors.forename: Jerrold
authors.initials: J
authors.lastname: Hill
authors.forename: Howard
authors.initials: H
authors.lastname: Fillit
authors.forename: Sonali N
authors.initials: SN
authors.lastname: Shah
authors.forename: Megan C
authors.initials: MC
authors.lastname: del Valle
authors.forename: Robert
authors.initials: R
authors.lastname: Futterman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000191:economics / Q000453:epidemiology; D003153:Community Health Services / Q000191:economics / Q000706:statistics & numerical data*; D015897:Comorbidity; D017281:Cost of Illness; D015140:Dementia, Vascular / Q000191:economics / Q000453:epidemiology*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012016:Reference Values; D014600:Utilization Review