Costs of Alzheimer's disease (in Dutch); A study of the most important cost items of patients with Alzheimer's disease in the Netherlands and in France

The most frequently occurring type of dementia is Alzheimer's disease. Alzheimer's disease is a degenerative illness affecting the brain, decreasing the patient's memory and judgement. A cure is not available but it is possible to delay the cognitive decline with medication. New drugs like Aricept and Metrifonate appear to have no or minor side effects and have a positive effect on the cognitive functions and behavior of the patient. At this moment the iMTA is studying the cost-effectiveness of Metrifonate. This thesis is part of that study and focuses on the costs of Alzheimer's disease. The main question formulated in this thesis was: How do the costs of institutionalization compare with the costs of living at home for patients with Alzheimer's disease in The Netherlands and France? For The Netherlands earlier studies on the use of health care services by demented patients were used to estimate the costs for demented patients living at home. These costs depend on the amount of formal and informal health care services that demented patients use. The valuation of informal care also determines the amount of costs for patients living at home. The costs of living at home were compared with the costs of institutionalization. The costs of demented patients living at home are lower than the costs of institutionalization when informal care is not valued. When the costs of informal care are included in the costs for patients living at home, these costs exceed the costs of institutionalization for mildly demented patients as well as for severely demented patients by seven or more hours of informal care per day. A mildly demented patient probably does not need this amount of informal care per day. A severely demented patient could need seven hours of informal care per day. In that case costs of institutionalization are lower than the costs of living at home. In France admission of a mildly demented patient is cheaper when the patient needs more than two hours of informal care per day. As the severity of dementia increases, the increase in costs of institutionalization is not equal to the increase in costs of living at home. Therefore the thresholds at which the costs of living at home exceed the costs for institutionalization for a mildly demented patient does not equal the threshold for a severely demented patient. In comparison with The Netherlands, the costs for demented patients living at home in France are lower than in the Netherlands. This is caused by the increased use of informal care and the decreased use of professional health care services in France compared with the Netherlands. The costs of institutionalization are also higher in the Netherlands than in France. The costs of the French institutions are lower than the costs of institutions in the Netherlands because the emphasis is more on the function of living than on the function of caring. When informal care is valued with the same tariff used in the Netherlands, admission of a severely demented patient needing more than seven hours of informal care per day is cheaper than living at home. This last mentioned threshold is comparable with the Netherlands.