By Zissimopoulos, Julie
Aging Today , Vol. 34, No. 3
Much is said about the daunting cost of Alzheimer's disease, and for good reason: According to the Alzheimer's Association, in 2012, $200 billion was spent caring for Americans with Alzheimer's or other dementias. Given projections of steeply rising numbers of those with dementia in coming decades, it is natural to want to know what long-term costs face the United States. Such economic projections are far from simple, yet sufficiently nuanced predictions are now possible with the help of economic modeling tools.
Projecting Costs an Uncertain Business
The true cost of the disease, like the disease itself, is not completely understood and may never be, but we have tools to improve our estimates. We do not know the exact size of the current population of Americans with Alzheimer's disease because the diagnosis can only be confirmed after death. And some costs attributed to Alzheimer's disease stem from coexisting conditions, such as hypertension and diabetes.
But most importantly, expenditures on paid care for Alzheimer's disease are just one part of a larger picture: alongside these are the costs of care provided by unpaid caregivers who accounted for 17.4 billion hours of care in 2011, according to the Alzheimer's Association. Informal care involves costs in a broader sensethe cost of a person's time, of health impact, earnings and quality of life. Assigning a monetary value to the work of an unpaid individual is not easy. Estimates typically overlook such informal costs, suggesting that the estimate of $200 billion fell short of the true economic toll of this disease in 2012.
We do not know how many people will develop Alzheimer's- but the Alzheimer's Association predicts that by 2015 the number of people ages 65 and older with Alzheimer's may reach 7.1 million, a 40 percent increase from today. Then there is policy. Medicare and Medicaid may change in ways that will affect costs. If these programs reduced coverage for long-term care (both institutional and home) of individuals with Alzheimer's, public expenditures on these services would fall, but informal costs would likely rise. And there is the cost of treating caregivers whose own health may decline. These multiple unknowns make it challenging to project the costs associated with diagnosing and treating Alzheimer's.
Other Parts of the Picture
Despite the understandable focus on outlay, part of a full picture of the disease's economic impact is value: when money is spent on treatment, for example, what- and how much- might be gained? An improvement in a patient's health, a longer life, better quality of life for the patient and an informal caregiver- all indicate value. We need to understand costs and value, and in decision making, consider the two together. There will be value to treating the disease, even if it costs a lot to do so.
New medical technologies also form part of the picture- and add another layer of uncertainty. As the progression of Alzheimer's becomes more severe over time, costs increase. Presumably, if the disease's progression could be delayed, costs would fall. …