title: What Drives Country Differences in Cost of Alzheimer's Disease? An Explanation from Resource Use in the GERAS Study.
abstract: Country differences in resource use and costs of Alzheimer's disease (AD) may be driven by differences in health care systems and resource availability.
  
  
  
  To compare country resource utilization drivers of societal costs for AD dementia over 18 months.
  
  
  
  GERAS is an observational study in France (n = 419), Germany (n = 550), and the UK (n = 526). Resource use of AD patients and caregivers contributing to >1% of total societal costs (year 2010) was assessed for country differences, adjusting for participant characteristics.
  
  
  
  Mean 18-month societal costs per patient were France €33,339, Germany €38,197, and UK €37,899 (£32,501). Caregiver time spent on basic and instrumental activities of daily living (ADL) contributed the most to societal costs (54% France, 64% Germany, 65% UK). Caregivers in France spent less time on ADL than UK caregivers and missed fewer work days than in other countries. Compared with other countries, patients in France used more community care services overall and were more likely to use home aid. Patients in Germany were least likely to use temporary accommodation or to be institutionalized at 18 months. UK caregivers spent the most time on instrumental ADL, UK patients used fewest outpatient resources, and UK patients/caregivers were most likely to receive financial support.
  
  
  
  Caregiver time on ADL contributed the most to societal costs and differed across countries, possibly due to use of community care services and institutionalization. Other resources had different patterns of use across countries, reflecting country-specific health and social care systems.
authors.affiliation: Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Reed
authors.affiliation: Lilly Deutschland GmbH, Bad Homburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Happich
authors.affiliation: Divisió d'avaluació, Servei Català de la Salut, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Argimon
authors.affiliation: Parc Santari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: KI Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.|Centre for Research and Development, Uppsala University/Region of Gavleborg, Gävle, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Wimo
authors.affiliation: Clinica della Memoria, Department of Neurology & Psychiatry, University of Rome "Sapienza", Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruno
authors.affiliation: Department of Neurology, Philipps-University, Marburg, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Dodel
authors.affiliation: RICE (The Research Institute for the Care of Older People), >The RICE Centre, Royal United Hospital, Bath, UK.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Jones
authors.affiliation: Gerontopole, Alzheimer's Disease Research and Clinical Care, INSERM 1027, Toulouse University Hospital, Toulouse, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
authors.affiliation: Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Belger
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000191:economics* / Q000453:epidemiology*; D000704:Analysis of Variance; D017028:Caregivers / Q000191:economics; D015331:Cohort Studies; D017281:Cost of Illness; D005060:Europe / Q000453:epidemiology; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007391:International Cooperation; D008297:Male; D011795:Surveys and Questionnaires
keywords: Activities of daily living; Alzheimer’s disease; caregivers; costs; health resources