Abstract

Objective: In France, patients with Alzheimer’s disease (AD) represented about six per cent of elderly people aged 65 years and over in 2007. The total number of patients could double in 2020. Previous studies were carried out to measure costs of formal care utilization in AD, but only a few of them have focused on both informal and formal care costs. This research aimed at assessing time spent on care and costs for home-based patients with Alzheimer’s disease in France.

Data and methods: Interviews were conducted in 2009 and 2010, with a sample of 58 pairs composed of an Alzheimer’s patient living at home and his/her voluntary caregiver. Patients were recruited from three regional memory clinics at university hospitals. Resource Utilization for Dementia (RUD) questionnaires were adapted to provide a micro-costing approach taking into account a variety of resources used during the overall care process. These cost estimations were then compared with the French National Health Insurance data in order to ensure that they were consistent with what can be observed in a larger population with AD. To value time spent on informal care, two methods were performed: the opportunity cost method and the proxy good method. A multiple linear regression model was carried out to determine factors associated with hours spent monthly on caregiving. Eventually, the hypothesis for substitution between formal and informal care was tested with an interdependent system of linear regression equations by twostage least squares (2SLS) and three-stage least squares (3SLS).

Results: An equal number of males and females were enrolled. The mean age was 79 years old. On average, per patient, formal care and informal care respectively represented 16hr/month and 162hr/month. Informal care time was generally higher when the caregiver lived with the patient. No substitution between formal and informal care was observed using the 2SLS model. Mean total costs for four weeks were €2,635 (± 3,241) by the proxy good method and €3,450 (± 4,711) by the opportunity cost method. These costs significantly increase as the disease worsens: total costs were on average three times higher for severe levels of AD than for « mild » patients. However, whatever the severity of AD, informal care costs represented a significant part of total costs.

Policy implications: The results of our study, which are in line with previous research, suggest that providing formal care does not reduce the amount of informal care. Policymakers should take such a finding into consideration when they target paid home care. Giving respite to caregivers could allow them to organize their tasks and to reduce their burdens slightly, while the time spent for caregiving will still remain important.

Slides