Dataset Information

Association Between Cognition, Health Related Quality of Life, and Costs in a Population at Risk for Cognitive Decline.

ABSTRACT:

Background

The association between health-related quality of life (HRQoL) and care costs in people at risk for cognitive decline is not well understood. Studying this association could reveal the potential benefits of increasing HRQoL and reducing care costs by improving cognition.

Objective

In this exploratory data analysis we investigated the association between cognition, HRQoL utilities and costs in a well-functioning population at risk for cognitive decline.

Methods

An exploratory data analysis was conducted using longitudinal 2-year data from the FINGER study (n = 1,120). A change score analysis was applied using HRQoL utilities and total medical care costs as outcome. HRQoL utilities were derived from the Short Form Health Survey-36 (SF-36). Total care costs comprised visits to a general practitioner, medical specialist, nurse, and days at hospital. Analyses were adjusted for activities of daily living (ADL) and depressive symptoms.

Results

Although univariable analysis showed an association between cognition and HRQoL utilities, multivariable analysis showed no association between cognition, HRQoL utilities and total care costs. A one-unit increase in ADL limitations was associated with a -0.006 (p < 0.001) decrease in HRQoL utilities and a one-unit increase in depressive symptoms was associated with a -0.004 (p < 0.001) decrease in HRQoL utilities.

Conclusion

The level of cognition in people at-risk for cognitive decline does not seem to be associated with HRQoL utilities. Future research should examine the level at which cognitive decline starts to affect HRQoL and care costs. Ideally, this would be done by means of cross-validation in populations with various stages of cognitive functioning and decline.

SUBMITTER: Janssen N

PROVIDER: S-EPMC9535559 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association Between Cognition, Health Related Quality of Life, and Costs in a Population at Risk for Cognitive Decline.

Janssen Niels N Handels Ron L RL Wimo Anders A Antikainen Riitta R Laatikainen Tiina T Soininen Hilkka H Strandberg Timo T Tuomilehto Jaakko J Kivipelto Miia M Evers Silvia M A A SMAA Verhey Frans R J FRJ Ngandu Tiia T

Journal of Alzheimer's disease : JAD 20220101 2

<h4>Background</h4>The association between health-related quality of life (HRQoL) and care costs in people at risk for cognitive decline is not well understood. Studying this association could reveal the potential benefits of increasing HRQoL and reducing care costs by improving cognition.<h4>Objective</h4>In this exploratory data analysis we investigated the association between cognition, HRQoL utilities and costs in a well-functioning population at risk for cognitive decline.<h4>Methods</h4>An ...[more]

PMID: 35912737

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Project description:BackgroundHealth-related quality of life (HR-QoL) is an important outcome for patients and crucial for demonstrating the value of new treatments. Health utility estimates in subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are limited, especially in biomarker-confirmed populations. Besides, little is known about the longitudinal HR-QoL trajectory. This study aims to provide health utility estimates for SCD and MCI and investigate the QoL trajectory along the disease continuum.MethodsLongitudinal data from 919 SCD and 1336 MCI patients from the MEMENTO cohort were included. SCD was defined as clinical dementia rating (CDR) = 0, and MCI as CDR = 0.5. HR-QoL was measured using the EQ-5D-3L patient-reported instrument. Linear mixed-effect models (LMM) were used to assess the longitudinal change in HR-QoL and identify predictors of these changes.ResultsBaseline health utilities were 0.84 ± 0.16 and 0.81 ± 0.18, and visual analogue scale (VAS) were 75.8 ± 14.82 and 70.26 ± 15.77 in SCD and MCI. In amyloid-confirmed cases, health utilities were 0.85 ± 0.14 and 0.86 ± 0.12 in amyloid-negative and amyloid-positive SCD, and 0.83 ± 0.17 and 0.84 ± 0.16 in amyloid-negative and amyloid-positive MCI. LMM revealed an annual decline in health utility of - 0.015 (SE = 0.006) and - 0.09 (SE = 0.04) in moderate and severe dementia (P < 0.05). There was a negative association between clinical stage and VAS where individuals with MCI, mild, moderate, and severe dementia were on average 1.695 (SE = 0.274), 4.401 (SE = 0.676), 4.999 (SE = 0.8), and 15.386 (SE = 3.142) VAS points lower than individuals with SCD (P < 0.001). Older age, female sex, higher body mass index, diabetes, cardiovascular history, depression, and functional impairment were associated with poor HR-QoL. Amyloid positivity was associated with an annual decline of - 0.011 (SE = 0.004, P < 0.05) health utility over time.ConclusionsHealth utility estimates from this study can be used in economic evaluations of interventions targeting SCD and MCI. Health utility declines over time in moderate and severe dementia, and VAS declines with advancing clinical stages. Amyloid-positive patients show a faster decline in health utility indicating the importance of considering biomarker status in HR-QoL assessments. Future research is needed to confirm the longitudinal relationship between amyloid status and HR-QoL and to examine the level at which depression and IADL contribute to HR-QoL decline in AD.

Project description:BackgroundCost-of-illness studies are widely used for healthcare decision-making in chronic conditions. Our aim was to assess the cost-of-illness of adult atopic dermatitis (AD) from the societal perspective in Hungary.MethodsWe conducted a multicentre, cross-sectional questionnaire survey between February 2018 and January 2021. Data was collected from consecutive AD patients aged ≥ 18 years and their physicians at dermatology departments in Hungary. We calculated direct and indirect costs, including costs for treatments, outpatient visits, hospital admissions, informal care, travel costs and productivity loss. To assess indirect costs, the Work Productivity and Activity Impairment (WPAI) questionnaire was used to collect data, and costs were estimated with the human capital approach. Generalized linear model was used to analyse predictors of total, direct and indirect costs.ResultsAltogether 218 patients completed the survey (57.8% female) with an average age of 31.3 (SD = 11.7). Patients' average Dermatology Life Quality Index (DLQI) score was 13.5 (SD = 8.5). According to Eczema Area and Severity Index (EASI) score, 2.3% (n = 5), 21.2% (n = 46), 54.4% (n = 118) and 22.1% (n = 48) had clear, mild, moderate, and severe AD, respectively. We found that the average total, direct medical, direct non-medical and indirect annual costs per patients were €4,331, €1,136, €747, and €2450, respectively, with absenteeism and presenteeism being the main cost drivers, accounting for 24% and 29% of the total cost of AD. A one-year longer disease duration led to, on average, 1.6%, and 4.2% increase in total and direct non-medical costs, respectively. Patients with worse health-related quality of life (higher DLQI score) had significantly higher total, direct medical, direct non-medical costs, and indirect costs.ConclusionsOur results indicate a substantial economic burden of AD from a societal perspective, mainly driven by productivity losses.

Project description:BackgroundHealth-related quality of life (HRQL) in interstitial lung disease (ILD) patients is impaired. We aimed to identify baseline predictors for HRQL decline within a 12-month observation period.MethodsWe analyzed 194 ILD patients from two German ILD-centers in the observational HILDA study. We employed the disease-specific King's Brief Interstitial Lung Disease questionnaire (K-BILD) with the subdomains 'psychological impact', 'chest symptoms' and 'breathlessness and activities', and the generic EQ-5D Visual Analog Scale (VAS). We evaluated how many patients experienced a clinically meaningful decline in HRQL. Subsequently, we investigated medical and sociodemographic factors as potential predictors of HRQL deterioration.ResultsWithin the study population (34.0% male, Ø age 61.7) mean HRQL scores hardly changed between baseline and follow up (K-BILD: 52.8 vs. 52.5 | VAS: 60.0 vs. 57.3). On the intra-individual level, 30.4% (n = 59) experienced a clinically relevant deterioration in K-BILD total score and 35.4% (n = 68) in VAS. Lower baseline forced vital capacity (FVC) % predicted determined HRQL decline in K-BILD total score (ß-coefficient: - 0.02, p = 0.007), VAS (ß-coefficient: - 0.03, p < 0.0001), and in the subdomain 'psychological impact' (ß-coefficient: - 0.02, p = 0.014). Lower baseline diffusing capacity of carbon monoxide (DLCO) % predicted determined deterioration in 'breathlessness and activities' (ß-coefficient: - 0.04, p = 0.003) and 'chest symptoms' (ß-coefficient: - 0.04, p = 0.002). Additionally, increasing age predicted decline in 'psychological impact' (ß-coefficient: 0.06, p < 0.007).ConclusionAround a third of ILD patients experienced a clinically relevant HRQL deterioration in a 12-month period, which was associated with baseline lung function values in all K-BILD domains. As lung function values are time-dependent variables with possible improvements, in contrast to age and ILD subtype, it, thus, seems important to improve lung function and prevent its decline in order to maintain HRQL on the possibly highest level.

Project description:BackgroundMost previous studies of effects of smoking on age-related cognitive decline have compared cognitive decline in current smokers, former smokers, and never smokers rather than investigating the effects of pack-years. The aim of the present study was to analyze the association between smoking and age-related cognitive decline in a sample of men administered the same intelligence test in young adulthood and late midlife, using pack-years between the two assessments as the primary measure of exposure to smoking.MethodsIn 5052 men, scores on a military intelligence test (BPP, Børge Priens Prøve) were available from young adulthood and a late midlife follow-up assessment including the same intelligence test and a comprehensive questionnaire on socio-demographic factors, lifestyle, and health. Information on smoking was self-reported at follow up for eight age periods, and pack-years were calculated from age 19 based on information on daily smoking and the duration of each age period. The differences in cognitive decline between adult-life smokers and non-smokers and the differences between light, moderate, and heavy smokers defined by pack-years were analyzed in linear regression models.ResultsAll smoking variables were only weakly associated with cognitive decline. Comparison of adult-life smokers and non-smokers showed less cognitive decline among smokers (1.12 IQ points, p < 0.001). Among smokers, analyses of pack-years suggested a weak dose-response relationship with more decline in heavy smokers than in light smokers (1.33 IQ points, p = 0.001). Independent of pack-years, current smoking was associated with larger cognitive decline than former smoking (1.73 IQ points, p < 0.001).ConclusionSmoking explained negligible fractions of the variance in cognitive decline, and thus our results did not indicate that smoking is a strong predictor of cognitive decline. The effects of pack-years suggest a relatively weak, possibly cumulative effect of smoking across the adult lifespan. The difference in decline between smokers and non-smokers may reflect participation bias and selective attrition at follow-up while the effects of current smoking may reflect either temporary effects of smoking or individual and life-style characteristics associated with continuation of smoking into late midlife.

Dataset Information

Association Between Cognition, Health Related Quality of Life, and Costs in a Population at Risk for Cognitive Decline.

Background

Objective

Methods

Results

Conclusion

Publications

Association Between Cognition, Health Related Quality of Life, and Costs in a Population at Risk for Cognitive Decline.

Similar Datasets

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