Krankheitskosten, gesundheitsbezogene Lebensqualität und Versorgungssituation bei Patienten mit kognitiven Defiziten

This study deals with the investigation of the medical costs as well as the quality of life of patients with cognitive deficits with the main focus on Alzheimer’s dementia. The goal of this study was to identify significant influences on costs and quality of life of patients with Alzheimer’s disease. This should facilitate im-portant decisions made by the health system concerning patients with dementia. The study at issue is a cross section survey including 177 patients with cognitive defi-cits. The study included 33 patients with mild cognitive impairment (MCI), 136 patients with Alzheimer’s dementia and 8 patients with mixed dementia. To evaluate the costs, patients as well as the caregiving relatives were given a questionnaire concerning the costs due to the patient’s dementia during the last three months. According to this data, we calculated direct, indirect and total costs per quarter. Patients and caregiving relatives were asked about the health related quality of life of the patient. This was done by using standardized measuring instruments for the dimen-sions of general health-related quality of life (EQ-5D) as well as Alzheimer-specific health-related quality of life (Qol-AD). Furthermore, patients were tested for possible depression (GDS) or neuropsychiatric or behavioural disorders (NPI). To evaluate the health status, we included data about the cognitive status (MMSE, ADAS-Cog) as well as comorbidities, overall health status and everyday competencies (ADCS-ADL). This extensive overall picture made it possible to identify influencing factors on costs and health-related quality of life of patients with Alzheimer’s disease as it hasn’t been done before in german studies. The total costs calculated in this study were € 3.030 ± 3.770 per quarter. This results in € 12.120 per year and patient. These costs composite of direct costs (75,3 percent) and indirect costs (24,7 percent). The biggest cost factor represents the cost of care with € 1.272 ± 1.460 and 42 percent of total costs. The analysis of influencing factors showed the biggest statistical correlation between costs and everyday competencies (ADCS-ADL, p=<0,001, r=0,590) as well as the resulting need for care (level of care, p=<0,001, r=0,684). Costs increased with progressing cognitive deficits, but these deficits were not the only ultimate driving factor of resource usage (MMSE, p=<0,001, r=-0,410). These results correlate with national as well as international findings in cost analysis for pa-tients with Alzheimer’s disease. The evaluation of the quality of life in patients with Alzheimer’s disease showed a lower level of quality of life compared with the average population. It also showed not only different results for the quality of life given by the patient and estimated by the relative, but different influencing factors. Patients rated their quality of life significantly higher than estimated by the caregiving relative. The most important influencing factor given by the patients was mood/depression. By contrast, the most important influencing fac-tors given by the relatives were the everyday competencies and the resulting need of care/dependency. This leads to the conclusion that if one chooses to evaluate the quali-ty of life of a dementia patient, one should include both the patient’s self-assessment as well as an external assessment done by a caregiver. The evaluation of the health care status of the patients showed an underprovision as well as an inappropriate provision in various aspects of health care. This involved espe-cially the medical care as well as the financial care (by example the „Demenzpauscha-le“). A better information policy for patients and caregiving relatives concerning financial aid and medical possibilities seems to be necessary.