We read with interest the article by Margaret Hux and colleagues on the association between cognitive function and the cost of caring for patients with Alzheimer's disease.1 We conducted a similar study in Italy.
We sampled 10 patients at each of 9 Italian centres for the care of patients with Alzheimer's disease. At each centre we collected information on the patients' degree of cognitive impairment, as indicated by the Mini-Mental State Examination,2 and the levels of care associated with different levels of impairment. We also surveyed sociodemographic characteristics of family caregivers and asked them to estimate the time and money the family devoted to caring for the family member with Alzheimer's disease. Italian National Health Service tariffs[3, 4] were used to estimate the cost of medical services and the replacement approach5 was applied to estimate the costs of informal care provided.
We analysed the association between cognitive function (using the classification system used by Hux and colleagues) and costs using multiple linear regression. Cost was logarithmically transformed to better fit a Gaussian distribution.
Seventy-six (84%) of the patients and their caregivers agreed to participate. The patients had a mean Mini-Mental State Examination score of 12.6 (standard deviation [SD] 5.8). Their mean age was 70.8 years (SD 8.7); 23% were men, 7.9% were living in an institution and a further 7.9% had been admitted to an institution in the previous 12 months. The mean age of the caregivers was 58.5 years (SD 13.2), and 44% were men. The yearly cost of care was estimated to be Can$61 852 (SD Can$34 375). Similar findings have been reported in other studies in Italy.[6, 7]
The level of cognitive function was significantly associated with the cost of caring for patients with Alzheimer's disease (p = 0.005). Costs were higher for older (p = 0.027) and wealthier (p = 0.094) caregivers and younger patients (p = 0.024).
In contrast to the findings of Hux and colleagues, the care of patients living in an institution cost significantly less than that of patients living at home (p = 0.039). One possible explanation is that nurses in institutions care for several patients simultaneously, decreasing the time devoted to each patient and thereby lowering costs.
Other than the relatively lower cost of caring for patients in institutions, our findings confirm those of Hux and colleagues.