Integrating intangible costs into societal cost estimates of Alzheimer's disease

BackgroundAlzheimer's disease (AD) is associated with considerable economic burden, the full extent of which can be challenging to quantify from a societal perspective.ObjectiveTo estimate the total societal cost of AD in the United States by integrating direct costs, out-of-pocket expenses, indirect costs to caregivers, costs to business, and intangible/emotional costs to patients/caregivers across the disease continuum from mild cognitive impairment (MCI) to severe AD.MethodsIntangible costs were derived from a patient-caregiver survey. Other indirect costs were from a Health and Retirement Study (HRS) analysis; direct costs were from the literature. We estimated integrated societal cost per patient per month (PPPM) for MCI and AD (mild/moderate/severe). Negative binomial regression of indirect costs examined associations with severity, adjusting for baseline characteristics.ResultsIntegrated societal costs PPPM were $4176 for MCI and $7873 for AD ($6,634, $7,291, and $9287 for mild, moderate, and severe, respectively); intangible costs represented 24-32% of societal costs. Indirect costs were higher with AD versus MCI (p < 0.001); married status and nursing home residence were associated with lower indirect costs in AD.ConclusionsIntangible costs are a major driver, besides direct costs, of the integrated societal cost of MCI/AD. Societal costs are higher with more severe AD.