Worldwide Dementia Costs Reach $604 Billion

Buoyed by 2 recent studies highlighting the enormous costs associated with dementia, advocates are pushing the White House and Congress to understand the disease’s severity, fund research to find treatments and a potential cure, and form a national strategy to combat dementia. Worldwide dementia-related costs are $604 billion and could increase 85% by 2030, according to the World Alzheimer Report 2010: The Global Economic Impact of Dementia released by Alzheimer’s Disease International in September. The London-based nonprofit organization comprises 73 national organizations throughout the world, including the Alzheimer’s Association in the United States.

In a separate report, Changing the Trajectory of Alzheimer’s Disease: A National Imperative, the Alzheimer’s Association estimated the total costs of caring for the 5.1 million Americans ≥65 years of age with Alzheimer’s disease (AD) is $172 billion per year and will increase to $1.08 trillion in 2050, a rise of >600%. By 2050, there will be 13.5 million Americans ≥65 years of age with AD, according to the report. AD is the most common form of dementia, with other types including vascular dementia, dementia with Lewy bodies, and frontotemporal dementia. Dementia, typically found in older people, is caused by numerous progressive illnesses affecting memory, thinking, behavior, and the ability to perform normal activities. After age 65, the likelihood of developing dementia nearly doubles every 5 years. Currently, there are 3 main federal legislative bills focused on AD.

The National Alzheimer’s Project Act (S 3036/HR 4689) would develop a federal strategic plan to address AD research, care, and services by creating an interagency advisory council. According to the Alzheimer’s Association, the legislation has 29 Senate cosponsors and 101 House of Representatives cosponsors. In addition, the Alzheimer’s Breakthrough Act (S1492/HR 3286) would increase the federal government’s AD funding by authorizing $2 billion per year in research funding and establish AD as a priority at the National Institutes of Health (NIH). According to the Alzheimer’s Association, the legislation has 45 Senate cosponsors and 131 House of Representatives cosponsors. Finally, the Health Outcomes, Planning, and Education for Alzheimer’s Act (S 3674/HR 5926) would provide Medicare reimbursement for services to increase the detection and diagnosis of AD and other forms of dementia as well as provide access and support for patients and families.

According to the Alzheimer’s Association, the legislation has 1 Senate cosponsor and 9 House of Representatives cosponsors. On September 21, AD advocates, researchers, health and long-term care experts, researchers, people living with AD, and others gathered at the White House to commemorate World Alzheimer’s Day and discuss dementia and potential strategies. Several members of President Barack Obama’s administration also attended: Howard Koh, MD, assistant secretary for health at the Department of Health and Human Services (DHHS); Kathy Greenlee, assistant secretary for aging at DHHS; Richard Hodes, MD, director of the National Institute on Aging at the NIH; and Nancy-Ann DeParle, director of the White House Office of Health Reform. “The largest takeaway is we need to act on this disease quickly,” Robert Egge, vice president, public policy and advocacy for the Alzheimer’s Association, told First Report Managed Care in an interview. “We need to have a national plan to deal with this crisis. We have no federal overarching support or plan. We need to approach this with the utmost seriousness.” The studies reinforced Mr. Egge’s concerns.

The Alzheimer’s Disease International report estimated 35.6 million people (approximately 0.5% of the world’s population) are living with dementia. In the next 20 years, costs in low- and middle-income countries are likely to rise faster than in high-income countries. The authors attributed their estimates to the fact that economic development in low- and middle-income countries will lead to larger per-person costs and that there will be a larger increase in the number of people with dementia in low- and middle-income countries. They forecast a 40% increase in the number of people with dementia in Europe, a 63% increase in North America, a 77% increase in southern Latin America, an 89% increase in the developed Asia Pacific countries, a 117% increase in east Asia, a 107% increase in south Asia, a 134% to 146% increase in the rest of Latin America, and a 125% increase in north Africa and the Middle East.

Currently, the average per-person cost of those with dementia is $32,865 in high-income countries (or approximately 1.24% of their gross domestic product [GDP]), $6827 in upper-middle-income countries (or approximately 0.50% of their GDP), $3109 in lower-middle-income countries (or approximately 0.35% of their GDP), and $868 in lowincome countries (or approximately 0.24% of their GDP). The cost per person is largest in North America ($48,605) and smallest in south Asia ($903). Furthermore, low-income countries accounted for <1% of worldwide costs but 14% of dementia’s prevalence; middle-income countries accounted for 10% of worldwide costs but 40% of the prevalence; and high income countries accounted for 89% of worldwide costs but 46% of the prevalence. Approximately 70% of dementia costs occurred in North America ($213 million) and Western Europe ($210 million).

The dementia costs cited for the United States in the Alzheimer’s Association report took into consideration the direct costs of care to all payers, including Medicare, Medicaid, out-of-pocket costs to people with conditions and their families, and costs to other payers such as private insurance, health maintenance organizations, and uncompensated care. The costs did not include the costs for Americans <65 years of age who have AD because the data are unavailable, nor does the figure include the $144 billion estimated cost of unpaid care provided by families and others. There are currently 5 drugs approved by the US Food and Drug Administration for treating AD symptoms: donepezil, galantamine, memantine, rivastigmine, and tacrine. The medications temporarily help memory and thinking problems in approximately 50% of patients, but they do not prevent, cure, or delay AD progression. There are several drugs in development that aim to modify the disease process by impacting ≥1 of the brain changes that AD causes.

The Alzheimer’s Association report hypothesized that if a treatment became available in 2015 and could delay the age of onset of AD by 5 years, the number of people ≥65 years of age with AD would decrease from 5.6 million to 4 million in 2020. The authors assumed the drug would show its effects immediately. “We remain hopeful these drugs [in development] can prove to have disease-modifying therapy, something to change the course of the disease,” Mr. Egge said. “We are galvanizing to cure the disease or even delay the onset of the disease.... We are going to judge success based on outcomes and results. We’ve succeeded when we see changes to increase research funding and better care.”—Tim Casey