Phase‐specific health system costs of dementia in Ontario, Canada: A propensity score‐matched cohort study
Bibliographic record
Abstract
Abstract Background Due to increases in the prevalence of dementia across Canada, the economic burden of dementia on provincial health systems is expected to rise. A better understanding of the phase‐specific costs of dementia care, such as periods immediately prior to and following diagnosis as well as other critical points in the life course are needed to support capacity planning. We estimated the phase‐specific costs of dementia over time among older adults and by sex. Method We identified a cohort of 164,640 Ontario residents aged 66+ years, ascertained with incident dementia and residing in the community between April 1st, 2010 and March 31st, 2017. Controls, who had no previous dementia diagnosis, were 1:1 propensity‐score matched to persons with dementia and individuals were followed to death or study end (March 31st, 2018). Costs included inpatient care, emergency department care, ambulatory care, home care, long‐term care, physician and healthcare professional services, and prescription drugs. Phase‐based costing methodology examined mean net costs of dementia care throughout four phases of disease progression (pre‐diagnosis, initial, continuing, terminal) and 5‐year net costs. Result Persons with dementia and matched controls (mean age 81.3 years; 58.7% female) were followed for an average of 3.2 years. Mean net costs of dementia were highest in the terminal phase ($32,679), followed by the initial ($17,656) and continuing phases ($13,423). Higher costs in the dementia group in the terminal phase were driven by acute care (net cost: $16,324, 95% CI [15,478, 17,170]) and long‐term care ($14,006, 95% CI [13,848, 14,164]). Net home care costs were highest in the initial phase ($1,839, 95% CI [1,796, 1,882]). The net 5‐year cost of dementia was $48,077 (95% CI [$47,183, $48,970]; women had higher 5‐year net costs than men ($50,158, 95% CI [$49,053, $51,263] vs. $44,800, 95% CI [$43,323, $46,277]). Conclusion Observed higher net costs of dementia in specific phases (terminal) and sectors (acute care, long‐term care, home care) highlight where to target interventions to optimize healthcare use and costs that respects quality of life for older adults with dementia and their family care providers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".