Societal Costs of Alzheimer's Disease: Informal Caregiver Burden and Patient Productivity Loss

OBJECTIVES: The direct medical costs associated with Alzheimer disease (AD) in the US have been estimated to be over $300 billion, but this value does not reflect the substantial financial burden on informal caregivers and society. We estimated the economic burden of informal caregivers and patient productivity loss due to AD across all severities to understand the total societal impacts of AD.

METHODS: We performed a narrative literature review to identify estimates of informal caregiver burden (time spent caregiving, caregiver out-of-pocket spending and increased caregiver healthcare resource utilization) and market productivity loss (patients not working due to AD and hours of work lost in those still employed). Additionally, we leveraged a predictive algorithm to estimate non-market productivity loss (household productivity, caregiving for others and volunteering) due to AD. All time was valued from a human capital perspective at an average total hourly compensation. Patient-level estimates were scaled to the population based on US AD prevalence (approximately 12.5 million), weighted by disease severity.

RESULTS: The total annual societal cost (informal caregiving and market and non-market productivity) of AD increased with severity: $50,195 for mild cognitive impairment due to AD, $81,517 for mild AD, $142,097 for moderate AD and $205,832 for severe AD. Considering the current distribution of prevalent patients across severity stages, the total annual cost societal burden was estimated at $1.1 trillion, which includes an estimated $855.6 billion in informal caregiving and $261 billion in productivity losses.

CONCLUSIONS: Conventional cost estimates, which do not consider informal caregiver burden and patient productivity loss, significantly underestimate the total burden of AD on individuals and society. Both elements of cost/burden should be incorporated into cost estimates and value assessment to best capture the total economic impact of a disease and the value of new disease therapies.