Dementia is a costly matter not only with regards for its management, but also for its diagnosis. We know that diagnosing dementia is not straightforward, and it often requires multiple visits to a doctor who may or may not be not skilled enough to recognize it and might need to refer to a specialist for further assessment. This will most probably involve another series of diagnostic tests for cases that are not obvious. We cannot stress more the importance of diagnosing dementia early-on for two reasons:
1) if diagnosed early, treatment and life-style changes can be started as soon as possible, which has been shown to greatly improve the quality of life and independence of people living with dementia;
2) one of the reasons for which there is to this day no drug treatment able to cure dementia or stabilize it, is that people with dementia are often diagnosed when the damage to the brain is to too advanced, preventing them from being recruited in medical trials designed to study drugs targeting the very early stages of the disease, when the damage to the brain is still somewhat contained.
Diagnosing dementia, however, can be quite costly, and even this may be one of the causes of late diagnosis.
Surprisingly, not much information or data regarding the exact cost of a dementia diagnosis exist to this day, and it’s important to keep in mind that the cost may differ vastly between different countries and healthcare systems.
One important and very indicative study was conducted very recently in a memory clinic in Germany, with the goal of analysing the cost of diagnosing dementia (or not) in 120 people visiting a memory clinic because of memory complaints. Researchers didn’t just consider the costs associated with consultations and tests, but also to those associated with loss of working time due to leave or sickness. It should also be noted that the calculated costs didn’t include any consultation or tests conducted by primary physicians before the referral to the specialist memory clinic.
Out of all the 120 people, 44% received a dementia diagnosis, 23% a Mild Cognitive Impairment diagnosis, while the remaining 33% received a different diagnosis which didn’t meet the standards for either dementia or MCI and had no indication of cognitive decline.
Cognitive tests, as well as other diagnostic tests were conducted (i.e. MRI, blood test, CSF, CT and PET), although not all the tests were necessary in every case.
They found out that reaching a definitive diagnosis is in fact a costly matter. All the patients payed a minimum of 110€ for the clinical consultation, which didn’t include further technical procedures as well as comprehensive neuropsychological assessments. Those with suspected dementia payed an additional 391€ for technical procedures. Researchers then observed how the price differed greatly between those who received a dementia diagnosis, who paid 659€, compared to those who were diagnosed with MCI or subjective memory complaints, who paid 376€. Out of all the dementia conditions, unspecified dementia was the costliest one (705€), while the cost associated to diagnosing Alzheimer’s disease and vascular/mixed dementia was slightly lower (649€ and 662€ respectively). The cost to diagnose MCI was very similar to that of diagnosing Alzheimer’s or vascular/mixed dementia (653€). The entire diagnostic process for someone with moderate to severe cognitive decline was 543€, while those showing no hint of cognitive decline faced a diagnostic process which costed about 434€.
The total cost for the entire diagnostic process for all 120 patients was about 60,120€, and based on the total number of true dementia diagnosis, the cost for one true dementia diagnosis was evaluated at 1134€, and conversely the cost for detecting non-dementia was 897€.
It is important to note that these costs were associated with just one memory clinic in Germany, and they could vary greatly between different regions of the country, as well as the reimbursement for diagnostic process, which are not standardized for different dementia diagnoses and associated costs.
source: Michalowsky, B., et al. (2017), Cost of diagnosing dementia in a German memory clinic, Alzheimer’s Research And Therapy, 9 (65).