痴呆的花费已超过癌症和心脏病

4月3日《新英格兰医学杂志》(New England Journal of Medicine)发表的一项研究显示，2010年，美国财政支出中痴呆的花费为1,590亿~2,150亿美元，使其成为较癌症或心脏病更大的财政负担。

Michael Hurd博士

加州圣塔莫尼卡市RAN老龄化研究中心主任Michael D. Hurd博士及其合作者使用健康和退休研究中的856例接受综合家庭临床痴呆评估的患者亚组，评估了美国的痴呆患病率和花费。研究者根据这些数据推算2000~2008年间所有70岁以上受试者的痴呆概率。估计社会痴呆花费的基础是每年每人的痴呆费用(41,000-56,000美元)，以及估计美国70岁以上老年人中痴呆患病率为14.7%(N. Engl. J. Med. 2013;368:1326-34)。

结果显示，2010年，美国财政支出中痴呆的花费为1,590亿~2,150亿美元。基于对看护者费用的估计，随着人口老龄化，预计到2040年这一数字将攀升至3,790亿~5,110亿美元。市场上痴呆治疗的直接花费已超过心脏病(1,020亿美元)或癌症(770亿美元)。多数痴呆相关费用为以家庭为基础的护理或长期护理机构提供的护理费用，而非其他医疗服务花费。

Hurd博士表示，新技术的使用为未来降低这些费用提供了可能性。例如，更好的远程医学可能减少长期护理机构中的人员配置。家庭辅助设备可能帮助看护者处理身体要求方面的工作。“即使我们未能证实医疗进步将延缓(痴呆的)发生，技术在降低医疗费用方面的作用可能也相当重要。”

研究者列出了多种费用数据，以反映从不同方面估计的无偿看护者提供的家庭护理的价值。在估计较高的情况下，对于无偿看护者费用的计算方式为确定从家庭式健康机构购买同等水平护理需要支付的费用。在较低的估计中，是基于看护者在劳动力市场上的价值。如果一位老年看护者已脱离工作岗位，则这一数值将很低。

该研究结论为，痴呆造成的社会经济负担已超过癌症和心脏病。提示政策制定者应加大对痴呆研究的投入。“痴呆确实在耗费我们的大量金钱，应该将一些资金投入到对这种疾病的探索和控制工作中。”

该研究得到国立衰老研究所(NIA)的一项基金资助，健康和退休研究是由密歇根大学进行的，并得到NIA和社会保障局提供的基金资助。

爱思唯尔版权所有  未经授权请勿转载

By: MARY ELLEN SCHNEIDER, Internal Medicine News Digital Network

Dementia cost the United States economy between $159 billion and $215 billion in 2010, making it a greater financial burden than either cancer or heart disease, according to a study published April 3 in the New England Journal of Medicine.

With the aging of the population, that number could climb to between $379 billion and $511 billion annually by 2040, depending on how caregiver costs are estimated. Already, the direct cost of dementia care purchased in the marketplace ($109 billion) is greater than what is spent on either heart disease ($102 billion) or cancer ($77 billion).
 
"We’re going to see an increasing fraction of our resources devoted to this disease," said Michael D. Hurd, Ph.D., a study author and the director of the RAND Center for the Study of Aging in Santa Monica, Calif.

The investigators relied on a subset of 856 patients who had undergone a detailed in-home clinical dementia assessment as part of the Health and Retirement Study to estimate both the prevalence and cost of dementia in the United States. Dr. Hurd and his associates extrapolated the data to estimate the probability of dementia for all study respondents older than 70 years from 2000 through 2008 (N. Engl. J. Med. 2013;368:1326-34).

Estimates of the societal costs of dementia are based on the yearly per-person cost of dementia ($41,000-$56,000) and an estimated prevalence of 14.7% among Americans older than age 70.

Most of the costs associated with dementia are for home-based care or care in a long-term care facility, not for other medical services, the researchers found.

Dr. Hurd said the use of technology offers some promise for reducing those costs in the future. For example, better telemedicine might allow for lower staffing levels at long-term care facilities. And home assistance devices that could help caregivers to handle physically demanding tasks, he said.

"The role of technology could be quite important in this even if we cannot find medical advances that would delay the onset [of dementia]," he said.

The researchers presented the costs in a range to reflect the different ways to estimate the value of in-home care provided by unpaid caregivers.

Under the higher estimates, unpaid caregiver costs are calculated by determining how much it would cost to purchase comparable care from a home health agency. The lower estimates are based on the value of the caregiver’s time in the labor market. In the case of an elderly caregiver who is out of the workforce, that number would be quite low, Dr. Hurd said.

The findings also offer a message to policymakers: Invest in dementia research. "If you’re a coldhearted person who doesn’t care about the emotional side, here’s something on the economic side that you can look at and say, ‘This really is costing us a lot of money, and we ought to put some dollars into seeing what we can do about it,’ " Dr. Hurd said.

The study was supported by a grant from the National Institute on Aging (NIA). The Health and Retirement Study is conducted by the University of Michigan and is supported by grants from the NIA and the Social Security Administration.