title: The economic impact of moderate stage Alzheimer's disease in Italy: evidence from the UP-TECH randomized trial.
abstract: BACKGROUND
  There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families.
  
  
  METHODS
  This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community.
  
  
  RESULTS
  The societal burden of AD, composed of public, patient, and informal care costs, was about €20,000/yr. Out of this, the cost borne by the public sector was €4,534/yr. The main driver of public cost was the national cash-for-care allowance (€2,324/yr), followed by drug prescriptions (€1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at €13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure.
  
  
  CONCLUSIONS
  The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org (
  
  
  BACKGROUND
  NCT01700556).
authors: Italian National Research Center on Aging (INRCA),Ancona,Italy.
authors: Carlos
authors: C
authors: Chiatti
authors: Italian National Research Center on Aging (INRCA),Ancona,Italy.
authors: Gianluca
authors: G
authors: Furneri
authors: Italian National Research Center on Aging (INRCA),Ancona,Italy.
authors: Joseph M
authors: JM
authors: Rimland
authors: Italian National Research Center on Aging (INRCA),Ancona,Italy.
authors: Federica
authors: F
authors: Demma
authors: Italian National Research Center on Aging (INRCA),Ancona,Italy.
authors: Franco
authors: F
authors: Bonfranceschi
authors: Italian National Research Center on Aging (INRCA),Ancona,Italy.
authors: Laura
authors: L
authors: Cassetta
authors: Marche Regional Health Agency,Ancona,Italy.
authors: Filippo
authors: F
authors: Masera
authors: Italian National Research Center on Aging (INRCA),Ancona,Italy.
authors: Antonio
authors: A
authors: Cherubini
authors: Italian National Research Center on Aging (INRCA),Ancona,Italy.
authors: Andrea
authors: A
authors: Corsonello
authors: Italian National Research Center on Aging (INRCA),Ancona,Italy.
authors: Fabrizia
authors: F
authors: Lattanzio
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000191:economics*; D017028:Caregivers / Q000191:economics*; D017281:Cost of Illness; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007558:Italy; D016014:Linear Models; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Alzheimer’s disease; RCT; UP-TECH; caregiver; community-living; cost analysis