title: Medical management, costs, and consequences of Alzheimer's disease in Germany: an analysis of health claims data.
abstract: OBJECTIVE
  The main objective of this analysis was to assess the medical and economic differences between patients with and without diagnosed Alzheimer's Disease (AD). Analysis included co-morbidities, patterns of drug use, and clinical course, as well as the magnitude of these differences attributable to AD.
  
  
  METHODS
  This evaluation is based on retrospective analyses of anonymized claims data from 2005-2008 provided by a large German Statutory Health Insurance (SHI). Cross-sectional analyses were performed with the following data: demographics, number of hospitalizations, number of in-patient days, number of ambulatory physician visits, number of drugs used, total number of defined daily doses (DDD) of prescribed drugs, and costs. A propensity score model was used to assess costs attributable to AD.
  
  
  RESULTS
  Patients with AD caused substantially higher costs from the perspective of a SHI. The differences in long-term care costs explained 70-75% of the total cost difference, with being responsible for about half of the total costs in AD patients. Comparing matched AD patients with controls resulted in 2.2-2.4-fold higher costs in the cross-sectional analysis, €7413-€9207 for AD patients vs €3378-€3850 for controls. The propensity score model resulted in a difference of €3771 attributable to AD. These costs are mainly caused by differences in hospitalization and long-term care costs.
  
  
  CONCLUSIONS
  This analysis is one of the largest health economic studies of AD in Germany. The limitations of this study include the fact that reported diagnosis couldn't be validated and disease severity was not taken into account. Despite these methodological constraints, it can be concluded that AD is a substantial cost driver from the SHI payer perspective in Germany.
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany, and Boston Healthcare Associates International GmbH , Berlin , Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Brüggenjürgen
authors.forename: Frank
authors.initials: F
authors.lastname: Andersohn
authors.forename: Nadja
authors.initials: N
authors.lastname: Ezzat
authors.forename: Loretto
authors.initials: L
authors.lastname: Lacey
authors.forename: Stefan
authors.initials: S
authors.lastname: Willich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D055553:Prescription Drugs / Q000191:economics; D057216:Propensity Score; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D055553:Prescription Drugs
keywords: Alzheimer’s disease; Health economic costs; Resource use