A Claims-Based Examination of Health Care Costs Among Spouses of Patients With Alzheimer's Disease.
BACKGROUND
Spouses of Alzheimer's disease patients (AD spouses) may experience substantial health effects associated with their partner's chronic cognitive and behavioral dysfunction. Studies examining associations between the medical experiences of AD spouses in the period before and after their partner's AD diagnosis are limited, particularly those which measure health care resource use and cost.


METHODS
AD patients were identified through multiple Medicare claims containing an AD diagnostic code. Their spouses were identified through special coding in the Medicare eligibility records. The AD spouses were matched demographically to the spouses of Medicare beneficiaries without a history of AD. Longitudinal and annual cross-sectional Medicare cost comparisons utilized log-transformed linear regression. The longitudinal period of observation began 12 months before the AD patient's initial claim listing AD and continued for up to 38 months afterwards.


RESULTS
The study identified 16,322 AD spouses. Total per person costs were 24% higher in AD spouses than in the controls ($694/month vs $561/month). AD spouses' excess costs began 3 months before their partners' AD diagnoses and continued for ≥30 months. Being an AD spouse predicted 29% higher Medicare costs after adjustment for chronic health status (P < .001). Increasing AD patient care complexity had a substantial impact on AD spouse Medicare costs (P < .001).


CONCLUSIONS
This study documents a link between the health status of AD spouses and AD patients. Additional research is required to elicit the mechanism behind the association between AD spouse and AD patient diagnosis.
JEN Associates, Cambridge, Massachusetts.
Daniel M
DM
Gilden
JEN Associates, Cambridge, Massachusetts.
Joanna M
JM
Kubisiak
Eli Lilly and Company, Indianapolis, Indiana.
Kristin
K
Kahle-Wrobleski
Eli Lilly and Company, Indianapolis, Indiana.
Daniel E
DE
Ball
Eli Lilly and Company, Indianapolis, Indiana.
Lee
L
Bowman
D000544:Alzheimer Disease / Q000453:epidemiology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007344:Insurance Claim Reporting; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D009735:Nursing Homes; D012044:Regression Analysis; D018454:Spouses / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
Alzheimers; Functional performance; Health services; Risk factors; Socioeconomic issues