title: Direct medical costs and source of cost differences across the spectrum of cognitive decline: a population-based study.
abstract: BACKGROUND
  Objective cost estimates and source of cost differences are needed across the spectrum of cognition, including cognitively normal (CN), mild cognitive impairment (MCI), newly discovered dementia, and prevalent dementia.
  
  
  METHODS
  Subjects were a subset of the Mayo Clinic Study of Aging stratified-random sampling of Olmsted County, MN, residents aged 70 to 89 years. A neurologist reviewed provider-linked medical records to identify prevalent dementia (review date = index). Remaining subjects were invited to participate in prospective clinical/neuropsychological assessments; participants were categorized as CN, MCI, or newly discovered dementia (assessment date = index). Costs for medical services/procedures 1-year pre-index (excluding indirect and long-term care costs) were estimated using line-item provider-linked administrative data. We estimated contributions of care-delivery site and comorbid conditions (including and excluding neuropsychiatric diagnoses) to between-category cost differences.
  
  
  RESULTS
  Annual mean medical costs for CN, MCI, newly discovered dementia, and prevalent dementia were $6042, $6784, $9431, $11,678, respectively. Hospital inpatient costs contributed 70% of total costs for prevalent dementia and accounted for differences between CN and both prevalent and newly discovered dementia. Ambulatory costs accounted for differences between CN and MCI. Age-, sex-, education-adjusted differences reached significance for CN versus newly discovered and prevalent dementia and for MCI versus prevalent dementia. After considering all comorbid diagnoses, between-category differences were reduced (e.g., prevalent dementia minus MCI (from $4842 to $3575); newly discovered dementia minus CN (from $3578 to $711)). Following the exclusion of neuropsychiatric diagnoses from comorbidity adjustment, between-category differences tended to revert to greater differences.
  
  
  CONCLUSIONS
  Cost estimates did not differ significantly between CN and MCI. Substantial differences between MCI and prevalent dementia reflected high inpatient costs for dementia and appear partly related to co-occurring mental disorders. Such comparisons can help inform models aimed at identifying where, when, and for which individuals proposed interventions might be cost-effective.
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. Electronic address: leibson@mayo.edu.
authors: Cynthia L
authors: CL
authors: Leibson
authors: K Long Health Economics Consulting LLC, St. Paul, MN, USA.
authors: Kirsten Hall
authors: KH
authors: Long
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors: Jeanine E
authors: JE
authors: Ransom
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors: Rosebud O
authors: RO
authors: Roberts
authors: Department of Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA.
authors: Steven L
authors: SL
authors: Hass
authors: Department of Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA.
authors: Amy M
authors: AM
authors: Duhig
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors: Carin Y
authors: CY
authors: Smith
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors: Jane A
authors: JA
authors: Emerson
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors: V Shane
authors: VS
authors: Pankratz
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors: Ronald C
authors: RC
authors: Petersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003072:Cognition Disorders / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D018672:Community Health Planning; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D003704:Dementia / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*
keywords: Cognitive status; Cost; Dementia; Economics; Mild cognitive impairment; Utilization