The cost-effectiveness analysis of those who living at home only  day care center and nursing home for patients with dementia among the different disease severity

ASIA unversity > 醫學暨健康學院 > 健康產業管理學系 > 長期照護組 > 博碩士論文 > Item 310904400/2376

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题名:	The cost-effectiveness analysis of those who living at home only day care center and nursing home for patients with dementia among the different disease severity
作者:	huang ya ch?
贡献者:	Department of Healthcare Administration/Healthcare Division
关键词:	Cost-Effectiveness、Caregiver、Quality of life、burden
日期:	2007
上传时间:	2009-11-06 05:36:44 (UTC+0)
摘要:	The aged population in Taiwan reached 9.7% of the total population in 2005. The prevalence of Dementia is between 1.6% and 6.4%; with every seven seconds there is a person who was diagnosed with Dementia. Different from other chronic diseases, the impairment of patients’ cognitive function will cause trouble in work, community life and mental disorder; as a result of these behaviors, the caregiver carry a great deal of pressure. Dementia patients not only suffer from the disease but also bring psychological burden for the caregiver and heavy economic load for government and family members. Studies show the national net cost for Dementia is NT$12.83 billion, averaging NT$128,349 to NT$910,685 per capita every year. In Australia and Japan, Dementia Disease has been taken seriously and policies on Dementia patients care are emphasized; while in Taiwan, few policies concerning Dementia patients care have been addressed. Therefore, from social perspective, this study intends to evaluate the economic cost of caring for Dementia patients of different level of illness with different care system, including homecare, daycare and nursing home. We perform comparative analysis for cost-effectiveness and also monetize the care time of main caregiver. Data of direct and indirect costs were obtained from health insurance claims from the National Health Research Institutes and questionnaires. Through interviews and fill-out forms, we collected the information concerning cost of the disease and quality of life and burden carried by the caregiver. Research subjects are Dementia patients and their main caregiver amongst a medical center in central Taiwan, a mental hospital in central Taiwan and a nursing home affiliated with a hospital. Consequently, we collected 143 questionnaires. Research results show the average cost for homecare per capita every year is NT$497,745, NT$612,254 for nursing home and NT$765,572 for daycare. Those caregivers of patients using nursing home have the best quality of life, while as those who using homecare have the worst quality of life. Considering the quality of life of caregiver, it is cost-effectiveness to use nursing home when the Dementia patients are in mild, moderate and extremely major conditions; while in major condition, it is cost-effectiveness to use homecare. Considering the burden of caregiver, it is cost-effectiveness for the caregiver to use homecare when the Dementia patients are in mild, major and extremely major conditions; while in moderate condition, it is cost-effectiveness to use daycare. This study only took into account the time cost and productivity loss of chief caregiver without considering the time cost of non-chief caregiver; hence the indirect cost might be underestimated. The daycare cost discussed in this study belongs to the healthcare system; therefore, it cannot represent the daycare cost in a social aspect. The research subjects locate in central Taiwan; so the research results are not necessarily applicable nationwide. According to the research results, we offered suggestion for future studies to examine cost-effectiveness of Dementia patients with different dementia subtypes and in different service style so that the caregiver can have better understanding which service is more cost-effective.
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