title: The relation between disease severity and cost of caring for patients with Alzheimer disease in Canada.
abstract: OBJECTIVE
  to characterize the cost of caring for an outpatient in Canada with Alzheimer disease (AD) based on disease severity, and to describe how costs change with increases in disease severity.
  
  
  METHODS
  community-dwelling patients with mild-to-moderate AD were enrolled in a 3-year, naturalistic, observational study. Assessments included cognition (Mini Mental Status Examination), global ratings (Global Deterioration Scale [GDS]), and daily function (Functional Autonomy Measurement System) as part of the Canadian Outcomes Study in Dementia. Direct (medical and nonmedical) and indirect costs were collected using resource use questionnaires. Costs at baseline were compared with costs at follow-up and correlated with disease severity.
  
  
  RESULTS
  total costs associated with treating AD were significantly higher with greater disease severity. The mean total cost to treat patients with very mild AD (GDS = 2) was $367 per month, compared with $4063 per month for patients with severe or very severe AD (GDS = 6). From baseline to follow-up, the greatest changes in cost were observed in the group of patients with the most severe AD as measured by all scales. The largest component of total cost was indirect costs at most severity levels, though medication costs contributed the most in patients with very mild AD. Significant independent contributors to cost were being female, having more impaired activities of daily living, and exhibiting more neuropsychiatric symptoms.
  
  
  CONCLUSIONS
  costs for treating a patient with AD were strongly associated with disease severity, even though none of the patients were institutionalized. Delaying the progression of AD may reduce indirect costs and burden to caregivers.
authors.affiliation: Medical Outcomes and Research in Economics (MORE) Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.forename: Derrick Y
authors.initials: DY
authors.lastname: Tam
authors.forename: Robert
authors.initials: R
authors.lastname: Balshaw
authors.forename: Robert
authors.initials: R
authors.lastname: Sambrook
authors.forename: Nadia
authors.initials: N
authors.lastname: Lesnikova
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lanctôt
mesh_terms: D000367:Age Factors; D000368:Aged; D000544:Alzheimer Disease / Q000191:economics* / Q000628:therapy; D002170:Canada; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors