Vascular Cognitive Impairment and Dementia Expenditures:

7-Year Inpatient Cost Description in Community Dwellers

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Ciro Ramos-Estebanez, MD; Ignacio Moral-Arce, PhD; Fernando Rojo, MD; Jesus Gonzalez-Macias, MD, PhD; Jose Luis Hernandez, MD, PhD

Table of Contents

Postgraduate Medicine:

Volume 124 No. 5

Category:

Clinical Focus

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DOI: 10.3810/pgm.2012.09.2597
Abstract:
Background: Vascular cognitive impairment (VCI) and vascular dementia (VaD) are prevalent conditions with a growing impact on health care expenses. Few studies have addressed expenditures on cognitive vascular disease. We quantify the expenses of tertiary-care inpatients with VCI and VaD and provide the first report on the specific cost of care in community-dwelling patients with small- and large-vessel ischemic cognitive disease. Methods: This is a cost-description study of inpatient expenditures from the Spanish National Health Institute and regional government perspectives. We retrospectively analyzed the expenses in a prospective cohort of 122 community dwellers with VCI who developed small-vessel disease with ischemic white matter disease (Binswanger’s disease) (n = 60), lacunar state (n = 26), or large-vessel disease (n = 36). Admissions with a primary or secondary diagnosis of transient ischemic attack or stroke, cognitive impairment or dementia, and other diagnoses related to cerebrovascular disease were assessed. Results: The average cost per patient was $33 740. The costs per VCI admission were similar across groups (~$9545). The average number of admissions increased during the progression of the disease (VCI, 1.2; VaD, 2.5) and contributed to higher expenses per patient during the VaD stage (~$22 631) compared with the VCI stage (~$11 110). Half of patients (n = 61; 50%) progressed without ischemic events during the VCI stage. These patients incurred lower per-patient costs during the VCI stage ($9750 vs $12 464), and costs increased during the post–VaD diagnosis stage ($28 528 vs $16 734). Conclusion: Large- and small-vessel cerebrovascular diseases are common and costly conditions. Vascular cognitive impairment presenting with stroke may incur greater expenses than VCI onset without stroke. Thus, patients with large-vessel disease incurred higher costs during the VCI stage. Care became more onerous at an advanced VaD stage in all groups. During the VaD stage, the expenditures of patients with Binswanger’s disease were significantly higher and eventually counterbalanced the initially lower costs seen during the VCI stage.

Keywords: small vessel; vascular cognitive impairment; vascular dementia; stroke; diagnosis-related group; cost