Incremental burden of congestive heart failure among elderly with Alzheimer's

Objective: A complex relationship exists between Alzheimer's disease (AD) and other co-existing co-morbidities such as congestive heart failure (CHF) with implications for health resource utilization (HRU) and cost of care. Study objective was to assess HRU and cost of care in elderly with AD and with or without concomitant CHF. Methods: All elderly (epsilon 65 years) from an academic healthcare system diagnosed with AD in 1999 (n = 904) and matched AD-free controls (n = 3616). Each group was subdivided into those with and without a CHF diagnosis. Costs and HRU were obtained from Medicare databases for 1999 and 2000. Costs and HRU were compared using ANOVA and Wilcoxon rank sum tests. Regressions were used to model the effect of AD and CHF on outcomes. Results: Mean annual cost were $20,888 for AD + CHF group, $5473 for only AD group, $17,700 for only CHF group and $4578 for the control group (no-AD and no-CHF). After adjusting for covariates, AD + CHF group had an eight-fold increase in total cost, while only CHF group had five-fold increase in total cost, compared to the control group. Regressions for inpatient costs, outpatient costs and inpatient pharmacy costs exhibited comparable trends. Conclusions: For elderly AD patients, a co-occurring diagnosis of CHF can result in a substantial increase in cost and HRU. This necessitates additional considerations if health care expenditures are to be reduced, particularly inpatient expenditure.