We recently wrote about a study conducted in Germany exploring the costs associated with a dementia diagnosis in that country. While not so many studies on the subject have been conducted in the past, one very similar study was in fact conducted in Sweden in 2013.
The study involved data from the Swedish Dementia Registry (SveDem), looking at 11,561 dementia patients diagnosed between 2007-2010, both in specialist and primary care centres. This is different from the German study which only looked at specialist setting.
They found out that, on average, specialists performed 4.6 diagnostic tests while the number was lower for primary care physicians, 2.8. Likewise, the cost associated to a dementia diagnosis performed by a specialist, 11,682 Swedish Crowns (roughly 1200 euros), was much higher than that associated to a diagnosis performed by a primary care physician, which was 6777 Swedish Crowns (about 700 euros). Researchers also observed great variations in cost between different Swedish regions. Furthermore, they stress how these numbers may not reflect the actual figures since only few primary care centres were included in the SveDem registry at the time of the study.
Nevertheless, they were able to identify three main takeaways from their research:
1) different diagnostic pathways are linked to age, i.e. the older a person is, the less diagnostic procedures and medical treatment are undertaken. This, however, does not necessarily mean that old people are discriminated against, but that the logistics and costs associated with diagnostics need to be weighed against potential benefits in the diagnostic precision. There are often a mixed pathology and comorbidities in older individuals, which may lead some clinicians to consider it less important to differentiate between e.g. Alzheimer’s or another type of dementia. Because of such comorbidities, older patients are also less likely to be treated with specific drugs such as acetylcholinesterase inhibitor drugs, usually prescribed to individuals with Alzheimer’s. On the contrary, younger individuals presenting cognitive decline are more commonly subjected to a greater number of diagnostic procedures because clinicians perceive a greater need to rule out other explanations for cognitive decline in the younger population;
2) diagnosis in a specialized clinic was way costlier than that in a primary care clinic. In this case the explanation is quite straightforward: specialists are needed when primary care physicians are not able to effectively diagnose, and diagnostic procedures in a specialist setting are necessarily more extensive;
3) there are great regional differences in the number of diagnostic activities and cost. Unfortunately, the reasons for this are not clear to the researchers, which think that economic strength and presence of university hospitals can only partially explain this variability.
source: Wimo, A., (2013), Costs Of Diagnosing Dementia, International Journal Of Geriatric Psychiatry, 28 (10), 1039 – 1044.