title: Predictors of Societal Costs in Dementia Patients and Their Informal Caregivers: A Two-Year Prospective Cohort Study.
abstract: OBJECTIVE
  Dementia poses a substantial economic burden on society. Knowing which factors predict high costs in dementia may help to better target interventions and optimize resource allocation. This study aimed to identify predictors of the total societal costs in dementia patients and their informal caregivers.
  
  
  METHODS
  Prospective cohort study with 2-year follow up.
  
  
  METHODS
  192 community-dwelling patients with dementia and their primary informal caregivers in the Netherlands.
  
  
  METHODS
  Data on health care resource utilization, informal carer time and caregivers' work absenteeism were collected by cost diaries and interviews. Predictors of total costs were identified for patient-caregiver dyads, and for patients and informal caregivers separately by performing univariate and multivariate generalized linear models.
  
  
  RESULTS
  Societal costs of patient-caregiver dyads averaged €75,084 (SEM: €4,263) in the first year and €99,369 (SEM: €6,441) in the second year. Sixty percent was attributed to costs of informal care. Patient impairments in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), disruptions during daily activities of the caregiver, and receiving case management were significantly associated with higher costs in dyads. The same predictors remained significant for patients' costs separately, and for informal caregivers, a poorer caregiver's quality of life and having more chronic diseases determined higher costs.
  
  
  CONCLUSIONS
  The societal costs of dementia are substantial and mainly due to high costs of informal care. The burden for caregivers caused by a disrupted schedule and patients' ADL and IADL dependencies contributed most to the total costs. Interventions targeting these factors effectively might result in relevant economic benefits for society.
authors.affiliation: VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Department of General Practice and Elderly Care Medicine, Amsterdam, The Netherlands. Electronic address: k.joling@vumc.nl.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: Joling
authors.affiliation: VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Department of General Practice and Elderly Care Medicine, Amsterdam, The Netherlands.
authors.forename: Jakob
authors.initials: J
authors.lastname: Schöpe
authors.affiliation: VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Department of General Practice and Elderly Care Medicine, Amsterdam, The Netherlands.
authors.forename: Hein P J
authors.initials: HP
authors.lastname: van Hout
authors.affiliation: VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Department of General Practice and Elderly Care Medicine, Amsterdam, The Netherlands.
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.affiliation: VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Department of General Practice and Elderly Care Medicine, Amsterdam, The Netherlands.
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
authors.affiliation: Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Bosmans
mesh_terms: D000041:Absenteeism; D000368:Aged; D017028:Caregivers / Q000191:economics* / Q000706:statistics & numerical data; D003704:Dementia / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D040841:Resource Allocation
keywords: Dementia; informal caregivers; longitudinal analysis; predictors; resource utilization; societal costs