title: Service utilization and health-care costs in the advanced elderly.
abstract: OBJECTIVE
  Despite their increasing importance, the advanced elderly are often neglected in service utilization and costing studies. The purpose of this study was to analyze from societal perspective service utilization and direct health-care costs and its predictors in the advanced elderly population.
  
  
  METHODS
  A bottom-up costing study was conducted using a cross-sectional primary care sample aged 75+ (n = 452) in Germany. The main instruments were a questionnaire of service utilization and costs administered by an interviewer and the chronic disease score (CDS). Predictors were derived by means of multivariate regression models.
  
  
  RESULTS
  Respondents caused mean direct costs of Euro 3730 (95% CI 3203-4257) in prices of 2004/2005. This included inpatient care 34%, pharmaceuticals 29%, outpatient physician services 15%, nursing care 10%, medical supply and dentures 6%, outpatient nonphysician providers 5%, assisted living 1%, and transportation 2%. A shift from lower to middle education and a one-point increase in CDS were associated with an increase of 1678 Euro (95% CI 250-3369) and 482 Euro (95% CI 316-654), respectively. Total mean direct costs did not differ significantly between sexes. Ischemic heart disease and diabetes mellitus were associated with excess costs of 711 Euro and 290 Euro, both being not significant. Altogether 55% of the respondents accounted for 90% of total direct costs.
  
  
  CONCLUSIONS
  Advanced elderly used a wide range of health services. Our study still underestimates the true costs to society. Further research should focus on economic evaluation of new health-care programs for this increasingly important age group.
authors.affiliation: University of Leipzig, Health Economics Research Unit, Department of Psychiatry, Leipzig, Germany. sven.heinrich@medizin.uni-leipzig.de
authors.forename: Sven
authors.initials: S
authors.lastname: Heinrich
authors.forename: Melanie
authors.initials: M
authors.lastname: Luppa
authors.forename: Herbert
authors.initials: H
authors.lastname: Matschinger
authors.forename: Matthias C
authors.initials: MC
authors.lastname: Angermeyer
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D018803:Models, Economic; D011446:Prospective Studies; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires