title: Direct and indirect costs and resource use in dementia care: A cross-sectional study in patients living at home.
abstract: BACKGROUND
  Due to the high prevalence of dementia, health care needs are increasing beyond existing formal resources. In Spain, it is the family that takes care of this disease.
  
  
  OBJECTIVE
  To analyze the direct (health and non-health) and indirect economic costs related to care of people with dementia living with their informal caregiver in the home care/community environment, from the perspective of illness severity, associated comorbidity and social impact.
  
  
  METHODS
  Multicentric, descriptive study.
  
  
  METHODS
  Three primary care public health centers associated with Hospital Clínic, Barcelona (Spain).
  
  
  METHODS
  Patients over 65 years old with a diagnosis of dementia, and included in a home care program.
  
  
  METHODS
  People with a diagnosis of dementia made by a specialist neurologist; aged 65 years or older; a score ≤ 24 on the Mini-Mental State Examination, and identification of an informal caregiver.
  
  
  METHODS
  Patients unable to identify an informal caregiver, and those with primary psychiatric pathology or Korsakoff's syndrome.
  
  
  METHODS
  Use of Resources in Dementia to assess costs; Mini-Mental State Examination to evaluate cognitive capacity; Katz-Index to measure functional capacity; Neuropsychiatric Index for neuropsychiatric symptoms, and the Charlson-Index for comorbidity. Data collection took place between November, 2010 and April, 2012.
  
  
  RESULTS
  The average estimated monthly care costs for people with dementia in the home setting are 1956.2€ (SD 1463.9). Informal care was the major contributor to this with a mean estimated cost of 1214.86 (SD 902.68)€/month. Greater illness severity, dependency in activities of daily living, comorbidity and behavioral disturbance are associated with higher costs. Behavioral disturbance appeared as the only factor independently associated with cost in dementia care. The group of people with dementia with severe behavioral disturbance requires the most care resources with an average cost of 2545.2 (SD 1753.2)€/month.
  
  
  CONCLUSIONS
  There is a direct association between dementia severity and increased costs. In addition, informal caregivers looking after people with dementia in Spain represent an important social cost. The independent factor associated with an increase in the total costs of patient care was neuropsychiatric symptoms.
authors.affiliation: Department of Nursing, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain. Electronic address: mfarre@clinic.ub.es.
authors.forename: Marta
authors.initials: M
authors.lastname: Farré
authors.affiliation: Parc Santari Sant Joan de Deu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: Transverse Group for Research in Primary Care, IDIBAPS, Barcelona, Spain.
authors.forename: Belchin
authors.initials: B
authors.lastname: Kostov
authors.affiliation: Department of Nursing, CAP Borrell, CAPSE, Primary Care, Comte Borrell, 305, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Alvira
authors.affiliation: Department of Nursing, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Ester
authors.initials: E
authors.lastname: Risco
authors.affiliation: School of Health Sciences Gimbernat i Tomàs Cerdà, UAB, Av. de la Generalitat, 202-206, Sant Cugat del Vallès, 08174 Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Miguel
authors.affiliation: School of Health Sciences TecnoCampus, Pompeu Fabra University, Ernest Lluch 32, 08032 Mataró, Spain.
authors.forename: Ester
authors.initials: E
authors.lastname: Cabrera
authors.affiliation: Department of Nursing Management, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain. Electronic address: azabaleg@clinic.ub.es.
authors.forename: Adelaida
authors.initials: A
authors.lastname: Zabalegui
mesh_terms: D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003704:Dementia / Q000191:economics / Q000451:nursing*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D013030:Spain
keywords: Community care; Dementia; Direct cost; Formal care; Home care; Indirect cost; Informal care