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On screen text: The cost of Alzheimer's disease.
Dr. Herrmann: I'm Nathan Herrmann. I'm a geriatric psychiatrist here at Sunnybrook Health
Sciences Centre, and I'm a professor of psychiatry at the University of
Toronto. I'm going to be talking to you about
COSID, which is the Canadian Outcome Study in Dementia. It was a 3-year
long tudinal study that looked at over 900
individuals from across Canada with mild dementia,
about 600 of which had Alzheimer's disease. And we
followed these individuals for 3 years using a variety of
different investigational tools.
We followed them for things like their degree of memory impairment and other
cognitive difficulties, we looked at their activities of daily living, their ability to
perform certain daily activities of living, and
their behaviours--any kind of problems they may have
had such as depression, or apathy, or
agitation--and then we asked
caregivers of these patients to estimate how much it cost to look after them.
And we looked at things such as the actual costs of
medicines, and physicians visits, and hospitalizations,
as well as the time away
from work or time away from leisure activity for the
caregivers. We found that it was very expensive
illness, and that the cost of looking after patients with Alzheimer's disease--
even those in the community who started out with mild to moderate
disease--increased dramatically as the disease
progressed, as it got more severe, and as it got more severe with respect
to their cognitive impairment, and as it got more severe
with respect to the activities of daily living that became impaired with the illness.
Dr. Lanctot: I'm Dr. Krista Lanctot. I'm a senior scientist here at Sunnybrook Health Sciences
Centre, I'm also a professor of psychiatry and pharmacology [. . .] at
at the University of Toronto. We found an astounding
increase by severity. If you look at the cost to take of one patient
with Alzheimer's per year, and compare the mild to the more severe
stages, in the mild stage it costs about $4,000 per year.
But when you move to the most severe stages, it moves up to
$48,000 per year, so 10 times higher and almost $50,000 per year.
The major cost driver when you get to severe is actually unpaid caregiver
time, or indirect costs. So this is lost productivity from
the caregiver who has to take care of the patients. The major
portion of that is when the patient loses their ability to do their basic
self-care. Dr. Herrmann: In previous studies, it was found that
one of the most important factors that contributed to costs associated
with Alzheimer's disease was the cost of institutionalization, so we wanted
to exclude that, and just look at what the cost was to people living
in the community. Dr. Lanctot: I think by the year 2035 there's going to be
over 1 million patients in Canada with Alzheimer's disease. It's
already one of the most expensive diseases, along with stroke. Dr. Herrmann: A lot of the cost
of the illness in this country are being paid for
by caregivers and not by the government,
not by society; it's directly out of the pockets of the caregivers themselves.
Dr. Lanctot: The caregiver really needs to have more supports in place.
The disease becomes more expensive, but we really have to put more
towards community supports for the caregivers.
The second important point is that we really need to find treatments that can delay
progression. If we can delay progression by 1 or 2 years,
we can really make a major impact on this disease.