ED3 Societal Burden of Dementia-Related Psychosis in the US: A Cost of Illness Analysis


      Dementia-related psychosis (DRP), characterized by hallucinations and delusions, may accelerate the cognitive/functional decline among patients with dementia. Such declines have debilitating consequences on patients, caregivers, and society. While previous research has estimated total annual-direct DRP costs, analysis of both direct and indirect costs is important in understanding the overall societal burden of DRP.


      To estimate the societal burden and associated costs of DRP in the US population.


      A Markov model was developed to assess the societal cost burden of DRP. The five DRP health states in the model were: mild, moderate, severe, end-of-life-care, and death as an absorbent health state. Cycle length was 30-days. Societal costs were calculated as a sum of total annual direct and indirect costs. Total indirect costs included both formal (paid by Medicare, Medicaid, or LTC insurance) and informal (caregiver time and patient out-of-pocket costs) caregiver costs, respectively. Prevalence, disease-severity, transition probabilities, and costs were derived from the literature. One-way sensitivity analysis was conducted to test the model’s robustness by varying inputs and assumptions.


      The estimated total annual-societal cost of DRP is $263B, and approximately $122B (46%) and $141B (54%) were indirect and direct costs, respectively. Of the total indirect costs, formal and informal caregiver costs including end-of-life-care costs were approximately $44.75B and $77.25B, respectively. End-of-life-care contributed $10B and $22B of the total formal and informal caregiver costs, respectively.


      Results of this analysis demonstrate that indirect costs contribute to approximately half of the total annual societal DRP costs; with caregiver costs contributing nearly 30% of the total. Given the aging US population, in addition to direct costs, indirect costs related to the caregiver and out-of-pocket costs may impose an enormous burden on the healthcare system. Given this public health concern, better management strategies and improved therapeutic options for DRP are needed.