title: Relationship between patient dependence and direct medical-, social-, indirect-, and informal-care costs in Spain.
abstract: OBJECTIVE
  The objectives of this analysis were to examine how patients' dependence on others relates to costs of care and explore the incremental effects of patient dependence measured by the Dependence Scale on costs for patients with Alzheimer's disease (AD) in Spain.
  
  
  METHODS
  The Co-Dependence in Alzheimer's Disease study is an 18 multicenter, cross-sectional, observational study among patients with AD according to the clinical dementia rating score and their caregivers in Spain. This study also gathered data on resource utilization for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. The data of 343 patients and their caregivers were collected through the completion of a clinical report form during one visit/assessment at an outpatient center or hospital, where all instruments were administered. The data collected (in addition to clinical measures) also included sociodemographic data concerning the patients and their caregivers. Cost analysis was based on resource use for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. Resource unit costs were applied to value direct medical-, social-, and indirect-care costs. A replacement cost method was used to value informal care. Patient dependence on others was measured using the Dependence Scale, and the Cumulative Index Rating Scale was administered to the patient to assess multi-morbidity. Multivariate regression analysis was used to model the effects of dependence and other sociodemographic and clinical variables on cost of care.
  
  
  RESULTS
  The mean (standard deviation) costs per patient over 6 months for direct medical-, social-, indirect-, and informal-care costs were estimated at €1,028.10 (€1,655.00), €843.80 (€2,684.80), €464.20 (€1,639.00), and €33,232.20 (€30,898.90), respectively. Dependence was independently and significantly associated with direct medical-, social-, informal-, and total-care costs.
  
  
  CONCLUSIONS
  The costs of care for patients with AD in Spain are substantial, with informal care accounting for the greatest part. Interventions that reduce patient dependence on caregivers may be associated with important reduction in direct medical-, social-, informal-, and total-care costs.
authors.affiliation: Department of Economics, University of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Darbà
authors.affiliation: BCN Health Economics and Outcomes Research SL, Barcelona, Spain.
authors.forename: Lisette
authors.initials: L
authors.lastname: Kaskens
keywords: Alzheimer; Dependence Scale; direct medical care costs; indirect care costs; informal care costs; social care costs