Evaluated need, costs of care, and payer perspective in degenerative dementia patients cared for in the United States

The purpose of this study was to examine the strength of the associations between 5 measures of need that are potentially modifiable in degenerative dementia patients and direct costs of care from 5 payer perspectives in the US healthcare system. Data were derived from a cohort study of 150 patients with a degenerative dementia. We measured need variables at baseline and utilization of healthcare in the year before and after baseline. Utilization data were converted into estimated direct costs and totaled based on the costs paid for by 5 payers in the US healthcare system. Path models were used to quantify and compare the relationships between need variables and direct costs. From Medicare's perspective, comorbid medical conditions were the most important predictor of Medicare costs. From Medicaid's perspective, neuropsychiatric symptoms and signs of parkinsonism were additional significant predictors. From the perspective of patients, their families and society, all 5 need variables were significant predictors of direct costs (ie, those above, plus cognitive impairment, and dependency). The relationship between evaluated need variables and direct costs depends on the perspective of the payer and provide insights into which need variables could be targeted with interventions to control costs and improve patient outcomes.