Costs explained by function rather than diagnosis--results from the SNAC Nordanstig elderly cohort in Sweden.
BACKGROUND
Because the prevalence of many brain disorders rises with age, and brain disorders are costly, the economic burden of brain disorders will increase markedly during the next decades.


OBJECTIVE
The purpose of this study is to analyze how the costs to society vary with different levels of functioning and with the presence of a brain disorder.


METHODS
Resource utilization and costs from a societal viewpoint were analyzed versus cognition, activities of daily living (ADL), instrumental activities of daily living (IADL), brain disorder diagnosis and age in a population-based cohort of people aged 65 years and older in Nordanstig in Northern Sweden. Descriptive statistics, non-parametric bootstrapping and a generalized linear model (GLM) were used for the statistical analyses.


RESULTS
Most people were zero users of care. Societal costs of dementia were by far the highest, ranging from SEK 262,000 (mild) to SEK 519,000 per year (severe dementia). In univariate analysis, all measures of functioning were significantly related to costs. When controlling for ADL and IADL in the multivariate GLM, cognition did not have a statistically significant effect on total cost. The presence of a brain disorder did not impact total cost when controlling for function. The greatest shift in costs was seen when comparing no dependency in ADL and dependency in one basic ADL function.


CONCLUSIONS
It is the level of functioning, rather than the presence of a brain disorder diagnosis, which predicts costs. ADLs are better explanatory variables of costs than Mini mental state examination. Most people in a population-based cohort are zero users of care.
Department of Health Economics, Stockholm School of Economics, Stockholm, Sweden.
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Lindholm
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Gustavsson
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Jönsson
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Wimo
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000191:economics* / Q000503:physiopathology / Q000523:psychology; D010054:Brief Psychiatric Rating Scale; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D011788:Quality of Life; D013548:Sweden