Incremental burden of congestive heart failure among elderly with Alzheimer's.
OBJECTIVE
A complex relationship exists between Alzheimer's disease (AD) and other co-existing co-morbidities such as congestive heart failure (CHF) with implications for health resource utilization (HRU) and cost of care. Study objective was to assess HRU and cost of care in elderly with AD and with or without concomitant CHF.


METHODS
All elderly (> or =65 years) from an academic healthcare system diagnosed with AD in 1999 (n = 904) and matched AD-free controls (n = 3616). Each group was subdivided into those with and without a CHF diagnosis. Costs and HRU were obtained from Medicare databases for 1999 and 2000. Costs and HRU were compared using ANOVA and Wilcoxon rank sum tests. Regressions were used to model the effect of AD and CHF on outcomes.


RESULTS
Mean annual cost were 20,888 US dollars for AD + CHF group, 5,473 US dollars for only AD group, 17,700 US dollars for only CHF group and 4,578 US dollars for the control group (no-AD and no-CHF). After adjusting for covariates, AD + CHF group had an eight-fold increase in total cost, while only CHF group had five-fold increase in total cost, compared to the control group. Regressions for inpatient costs, outpatient costs and inpatient pharmacy costs exhibited comparable trends.


CONCLUSIONS
For elderly AD patients, a co-occurring diagnosis of CHF can result in a substantial increase in cost and HRU. This necessitates additional considerations if health care expenditures are to be reduced, particularly inpatient expenditure.
Chhatre
Sumedha
S
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA. rasu@mail.med.upenn.edu
Weiner
Mark G
MG
Jayadevappa
Ravishankar
R
Johnson
Jerry C
JC
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000191:economics*; D016022:Case-Control Studies; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000150:complications / Q000191:economics* / Q000628:therapy; D006801:Humans; D007345:Insurance Claim Review / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics; D012189:Retrospective Studies; D014481:United States