Attributable Cost of Dementia: Demonstrating Pitfalls of Ignoring Multiple Health Care System Utilization
Corresponding Author
Lianlian Lei M.A.
VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
Address correspondence to Lianlian Lei, M.A., VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC; and also Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., 3.161U, Rochester, NY 14642; e-mail: [email protected]. Search for more papers by this authorSusan G. Cooley Ph.D.
VHA Office Geriatrics & Extended Care, U.S. Dept. Veterans Affairs, Washington, DC
Search for more papers by this authorCiaran S. Phibbs Ph.D.
VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC
Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
Department of Pediatrics—Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA
Search for more papers by this authorBruce Kinosian M.D.
VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC
Division of Geriatrics, University of Pennsylvania, Philadelphia, PA
Search for more papers by this authorRichard M. Allman M.D.
George Washington University School of Medicine, Washington, DC
Search for more papers by this authorAnton P. Porsteinsson M.D.
Department of Psychiatry, University of Rochester School ofMedicine and Dentistry, Rochester, NY
Search for more papers by this authorOrna Intrator Ph.D.
VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
Search for more papers by this authorCorresponding Author
Lianlian Lei M.A.
VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
Address correspondence to Lianlian Lei, M.A., VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC; and also Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., 3.161U, Rochester, NY 14642; e-mail: [email protected]. Search for more papers by this authorSusan G. Cooley Ph.D.
VHA Office Geriatrics & Extended Care, U.S. Dept. Veterans Affairs, Washington, DC
Search for more papers by this authorCiaran S. Phibbs Ph.D.
VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC
Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
Department of Pediatrics—Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA
Search for more papers by this authorBruce Kinosian M.D.
VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC
Division of Geriatrics, University of Pennsylvania, Philadelphia, PA
Search for more papers by this authorRichard M. Allman M.D.
George Washington University School of Medicine, Washington, DC
Search for more papers by this authorAnton P. Porsteinsson M.D.
Department of Psychiatry, University of Rochester School ofMedicine and Dentistry, Rochester, NY
Search for more papers by this authorOrna Intrator Ph.D.
VHA Office Geriatrics & Extended Care Data Analysis Center (GECDAC), Washington, DC
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
Search for more papers by this authorAbstract
Objectives
To determine dementia prevalence and costs attributable to dementia using Veterans Health Administration (VHA) data with and without Medicare data.
Data Sources
VHA inpatient, outpatient, purchased care and other data and Medicare enrollment, claims, and assessments in fiscal year (FY) 2013.
Study Design
Analyses were conducted with VHA data alone and with combined VHA and Medicare data. Dementia was identified from a VHA sanctioned list of ICD-9 diagnoses. Attributable cost of dementia was estimated using recycled predictions.
Data Collection
Veterans age 65 and older who used VHA and were enrolled in Traditional Medicare in FY 2013 (1.9 million).
Principal Findings
VHA records indicated the prevalence of dementia in FY 2013 was 4.8 percent while combined VHA and Medicare data indicated the prevalence was 7.4 percent. Attributable cost of dementia to VHA was, on average, $10,950 per veteran per year (pvpy) using VHA alone and $6,662 pvpy using combined VHA and Medicare data. Combined VHA and Medicare attributable cost of dementia was $11,285 pvpy. Utilization attributed to dementia using VHA data alone was lower for long-term institutionalization and higher for supportive care services than indicated in combined VHA and Medicare data.
Conclusions
Better planning for clinical and cost-efficient care requires VHA and Medicare to share data for veterans with dementia and likely more generally.
Supporting Information
| Filename | Description |
|---|---|
| hesr13048-sup-0001-AppendixSA1.pdfPDF document, 1.2 MB | Appendix SA1: Author Matrix. |
| hesr13048-sup-0002-TablesS1-S7.docxWord document, 72.6 KB |
Table S1: List of ICD-9 Codes for Comorbidities. Table S2: Descriptive Statistics for Market Characteristics. Table S3: Descriptive Statistics for Priority Group and Comorbidities among Veterans Age 65 and Older Who Used Veteran Health Administration (VHA) by VHA or Combined VHA and Medicare Recorded Dementia in FY 2013. Table S4: Association of Dementia with Cost to Veteran Health Administration (VHA), Medicare or Combined among Veterans Age 65 and Older Who Used VHA By Using VHA Data alone or Combined VHA and Medicare Data in FY 2013 (GEE Model). Table S5: Expected Costs per Veteran per Year Based on Recycled Prediction (Estimate/95% CI). Table S6: Sensitivity Analysis – Attributable Cost of Dementia among Veterans Age 65 and Older Who Used Veteran Health Administration (VHA) Using VHA Data Alone or Combined VHA and Medicare Data in FY 2013. Table S7: Descriptive Statistics for Characteristics among Veterans Age 65 and Older Who Used Veteran Health Administration (VHA) by VHA Only, Medicare only, and both VHA and Medicare Reported Dementia using combined VHA and Medicare data in FY 2013. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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