title: The costs of dementia from the societal perspective: is care provided in the community really cheaper than nursing home care?
abstract: OBJECTIVE
  To compare the costs of care for community-dwelling dementia patients with the costs of care for dementia patients living in nursing homes from the societal perspective.
  
  
  METHODS
  Cross-sectional bottom-up cost of illness study nested within the multicenter German AgeCoDe-cohort.
  
  
  METHODS
  Community and nursing homes.
  
  
  METHODS
  One hundred twenty-eight community-dwelling dementia patients and 48 dementia patients living in nursing homes.
  
  
  METHODS
  None.
  
  
  METHODS
  Utilization and costs of medical care and long term care, including formal and informal social and nursing care based on proxy interviews. Informal care was valued using the replacement cost method.
  
  
  RESULTS
  Unadjusted mean annual total costs including informal care were €29,930 ($43,997) for community-dwelling patients and €33,482 ($49,218) for patients living in nursing homes. However, multiple regression analysis controlling for age, sex, deficits in basic and instrumental activities of daily living and comorbidity showed that living in the community significantly increased total costs by €11,344 ($16,676; P < .01) compared with living in a nursing home, mainly due to higher costs of informal care (+€20,585; +$30,260; P < .001).
  
  
  CONCLUSIONS
  From the societal perspective care for dementia patients living in the community tends to cost more than care in nursing homes when functional impairment is controlled for.
authors: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: h.koenig@uke.de.
authors: Hans-Helmut
authors: HH
authors: König
authors: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Hanna
authors: H
authors: Leicht
authors: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Christian
authors: C
authors: Brettschneider
authors: Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Cadja
authors: C
authors: Bachmann
authors: Department of Psychiatry, Technical University of Munich, Munich, Germany.
authors: Horst
authors: H
authors: Bickel
authors: Department of General Practice, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
authors: Angela
authors: A
authors: Fuchs
authors: Department of Psychiatry, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
authors: Frank
authors: F
authors: Jessen
authors: Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Mirjam
authors: M
authors: Köhler
authors: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors: Melanie
authors: M
authors: Luppa
authors: Department of Psychiatry, Technical University of Munich, Munich, Germany.
authors: Edelgard
authors: E
authors: Mösch
authors: Department of General Practice, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
authors: Michael
authors: M
authors: Pentzek
authors: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors: Jochen
authors: J
authors: Werle
authors: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors: Siegfried
authors: S
authors: Weyerer
authors: Institute of Biometrics, Hannover Medical School, Hannover, Germany.
authors: Birgitt
authors: B
authors: Wiese
authors: Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Martin
authors: M
authors: Scherer
authors: Department of Psychiatry, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
authors: Wolfgang
authors: W
authors: Maier
authors: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors: Steffi G
authors: SG
authors: Riedel-Heller
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D017028:Caregivers / Q000191:economics*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000191:economics* / Q000453:epidemiology; D004185:Disability Evaluation; D005260:Female; D005858:Germany / Q000453:epidemiology; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000191:economics*; D012044:Regression Analysis; D012720:Severity of Illness Index
keywords: Cost-of-illness; dementia; informal care; nursing home