cost of dementia in india

Cost of Dementia in India

Srikala Bharath & Girish N. Rao1

NIMHANS, India

Dr. Srikala Bharath DPM, MD, DC,AP FRCPsych

Professor of Psychiatry,[email protected]

1Dr. Girish N. Rao, MD

Associate Prof Epidemiology

NIMHANS, Bangalore, India

mailto:[email protected]

Disclosure

• No Conflicts of Interest

Srikala Bharath, India Cost of Dementia, ADI 2012

2

Dementia – so what?

DEMENTIA IS A CONDITION OF THE ELDERLY INDIA IS GRAYING RAPIDLY

3Srikala Bharath, India Cost of Dementia, ADI 2012

AGE PYRAMID


New estimates for India

0

5

10

15

20

2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

3.7

6.4

12.5

millions


Az

Cost of Illness

• Direct Cost – Medical and Non Medical (social)

• Indirect cost – Loss of Productivity, Wages, Transportation etc • Intangible cost – Suffering, Pain etc Direct Cost - Out of Pocket Cost (OOPs)


Cost of Dementia

• WHY ASSESS COD?• Provides the Economic Burden of

Dementia • Informed Choices can be made by the

government about priorities in Elderly - Which Health issues to be

addressed - Which interventions work - Policies /Program 9Srikala Bharath, India

Cost of Dementia, ADI 2012

Earlier Estimates

Wimo et al (2010) Alz & Dementia Cost in 2009• Based on prevalence, country specific GDP per person,

average wage, Purchase Power Parity (PPP), available COD studies from different countries.

• 34.4 million PwD. • $ 422 million in 2009• $ 142 million for informal care (34%)• Depending on quantum of Informal care (1.6 hrs/ day or

3.7 hrs/day) the cost varied from $142 to 329 million.• An increase of 34% in the cost from 2005 to 2009 incl.

18% increase in fixed costs. • 77% of the cost is from more developed regions (MDR)

with 46% prevalence.


Cost of Dementia Care in India Wimo et al 2010

• Readjusted total societal cost of Dementia– US$ 9.4 to 13.7 million / INR 451 to 657 billion– Direct costs USD 6.1 million /INR 292 billion– Informal care 34 % 56%

• Annual cost / person – US$ 2, 295 (INR 96,850) to USD 5061 (INR

263,350)


Methodology• Desk work using a naturalistic approach. • Different components of care for PwD

comprehensively listed out during the brain storming session

• Cost the individual components of care:– experience and expert guesstimates.– Consensus on relative priority for care components

• Modified after feedback from families/ care providers

• Life cycle approach adopted to calculate life time costs of care for a PwD


Realities

Expenses incurred by 3 different persons • A person taken care by professional carers round the

clock at home in a city Rs. 14,000 p.m.• A person with AD who is staying in an old age home in

Chennai Rs. 9,000 p.m • A person staying in a small town and taken care of

by semi-trained carers Rs. 8,000 p.m.


Assumptions• Prevalence of dementia taken to be 3.69 million• PwD were functionally classified depending on need for

care and or medical attention: – Mild (30% of all PwD) need care and medical attention of some

level greater than a normal elderly; – Moderate (60% of all PwD) need extra care and medical

attention; – Severe (10% of all PwD) need special care all time around and

medical attention. • Survival of PwD was assumed to be 5 years, 3 years and

2 years for mild, moderate and severe cases respectively. • The human capital value to estimate cost of care-giving. • Over the counter rates of medication (cognitive

enhancers and anti-psychotics) of common Indian brands were enquired before assigning the costs of medications.


Needs, Components & Assumptions

Components and assumptions for costsNeed and Applicability

Mild Mod Severe

1.Medical Consultation ++;

100%++;

100%+++; 100%

2. Medication++;

100%++;

100%++;50%

3. Lost Productivity ++;100%

++;100%

++;100%

4. Informal Care Giving - ;100%

++;100%

+++;100%

5. Paid care / residential care by health aide- - ;NA

60% HIC 30% MIC

++;75% HIC 25% MIC


Needs, Components & Assumptions

Components and assumptions for costsNeed and Applicability

Mild Mod Severe

6. Hospitalization - ;Not expected

•+;10%

•++;20%

7. Day Care ++;10%

+;20%

- ;NA

8. Special Food - ;NA

+;33%

++;75%

9. House Modification +;

50%++;75%

+++;100%

Note: 1) -,, +, ++, +++ indicates the priority from lowest to highest 2) Applicability is the proportion of PwDs needing that particular service


Particulars Severity of Dementia Mild Moderate Severe

1) Medication 3,600 18,000 2,7002) Consultation 1,700 1,700 1,7003) Investigation (one time) 3,000 3,000 3,0004) Hospitalisation 0 2,000 4,0005) Transportation 1,200 1,200 8006) Paid / Residential care 0 27,600 1,05,0007) Day care 9,600 19,200 08) Lost Productivity 36,000 48,000 60,000

9) Informal Care (Opportunity Lost) 12,000 36,000 36,00010) Special food 0 2,970 20,25011) House modification (one time) 2,500 3,750 5,000


ParticularsSeverity of Dementia

Mild Moderate Severe

TOTAL cost per person 69,600 1,51,420 2,38,450

PwD (in millions) 1.107 2.214 0.369

Overall cost (in millions) 77,047 335,244 87,988

TOTAL for all PwD in India INR 500,279 million (house hold cost)


Particulars

Severity of Dementia

Mild Moderate Severe

Direct medical care 11.9% 16.3% 4.8%

Direct social care 15.5% 25.4% 38.1%

Informal care 72.6% 58.3% 57.1%


Projections

• Over a 10 year period, (after diagnosis, being as mild dementia for 5 years, moderate dementia as 3 years and severe dementia as 2 years), the total cost for an individual household would be nearly Rs 1.3 million.

• Compared to 2010, with average annual inflation of 10%, the costs would – more than double by 2025– increase five-fold by 2045 – seven times by 2050 20Srikala Bharath, India

Cost of Dementia, ADI 2012

Take home messages

• A comprehensive estimate• Realistic estimate• Household costs calculated• Several unanswered questions

– Most importantly what next?????


Work in the Geriatric Services, NIMHANS

• Household Burden of Dementia – cross sectional enquiry of 100 families with persons with dementia on their OOPS

• Cost of Dementia – a prospective study of 250 families over one year on their OOPS in persons with dementia in comparison to elderly with severe mental illness.

• Both initiated in 2011 Srikala Bharath, India

Cost of Dementia, ADI 2012 22

Thank you

• Acknowledgements : Dr. Girish Rao, Assoc. Prof Epidemiology, NIMHANS, Prof. M. Varghese, Dr. Sivakumar PT, Dept Psychiatry, NIMHANS, Geriatric Group

• Sanofi India – for new initiatives• Families of PwD and members of ARDSI


cost of dementia in india

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