Direct medical costs and source of cost differences across the spectrum of XXXX : A population-based study.

@entity303 @entity73 @entity1 @entity146
BACKGROUND: Objective cost estimates and source of cost differences are needed across the spectrum of cognition, including cognitively normal (CN), @entity73 ( @entity73 ), newly discovered @entity303 , and prevalent @entity303 . METHODS: Subjects were a subset of the Mayo Clinic Study of Aging stratified-random sampling of Olmsted County, MN, residents aged 70 to 89  years. A neurologist reviewed provider-linked medical records to identify prevalent @entity303 (review date  =  index). Remaining subjects were invited to participate in prospective clinical/neuropsychological assessments; @entity1 were categorized as CN, @entity73 , or newly discovered @entity303 (assessment date  =  index). Costs for medical services/procedures 1-year pre-index (excluding indirect and long-term care costs) were estimated using line-item provider-linked administrative data. We estimated contributions of care-delivery site and comorbid conditions (including and excluding neuropsychiatric diagnoses) to between-category cost differences. RESULTS: Annual mean medical costs for CN, @entity73 , newly discovered @entity303 , and prevalent @entity303 were  6042,  6784,  9431,  11,678, respectively. Hospital inpatient costs contributed 70% of total costs for prevalent @entity303 and accounted for differences between CN and both prevalent and newly discovered @entity303 . Ambulatory costs accounted for differences between CN and @entity73 . Age-, sex-, education-adjusted differences reached significance for CN versus newly discovered and prevalent @entity303 and for @entity73 versus prevalent @entity303 . After considering all comorbid diagnoses, between-category differences were reduced (e.g., prevalent @entity303 minus @entity73 (from  4842 to  3575); newly discovered @entity303 minus CN (from  3578 to  711)). Following the exclusion of neuropsychiatric diagnoses from comorbidity adjustment, between-category differences tended to revert to greater differences. CONCLUSIONS: Cost estimates did not differ significantly between CN and @entity73 . Substantial differences between @entity73 and prevalent @entity303 reflected high inpatient costs for @entity303 and appear partly related to co-occurring @entity146 . Such comparisons can help inform models aimed at identifying where, when, and for which individuals proposed interventions might be cost-effective.
