Clinical management and associated costs for moderate and severe Alzheimer’s disease in urban China: a Delphi panel study

Xin Yu, Shengdi Chen, Xiaochun Chen, Jianjun Jia, Chunhou Li, Cong Liu, Mondher Toumi, Dominique Milea

Healthcare resource utilisation for Alzheimer's disease (AD) in China is not well understood. This Delphi panel study aimed to describe the clinical management pathways for moderate and severe AD patients in urban China and to define the amount and cost of healthcare resources used. A panel of 11 experts was recruited from urban China to participate in two rounds of preparatory interviews. In the first round, 9 physicians specialised in dementia gave a qualitative description of the clinical management of AD patients. In the second round, 2 hospital administrators were asked about the cost of AD management and care. Results from the interviews were discussed by the experts in a Delphi panel meeting, where consensus was reached on quantitative aspects of AD management, including the rate of healthcare resource utilisation, the respective unit costs and caregiving time. Interviewees reported that mild AD is under-recognised in China; most patients are diagnosed with moderate to severe AD. Loss of independence and agitation/aggression are the main drivers for healthcare resource utilisation and contribute to a heavier caregiver burden. It was estimated that 70 % moderate AD patients are independent/non-aggressive at the time of diagnosis, 15 % are independent/aggressive, 10 % are dependent/non-aggressive, and 5 % are dependent/aggressive. Dependent/aggressive AD patients are more likely to be hospitalised (70-90 %) than accepted in a nursing home (0-20 %), while the opposite is true for dependent/non-aggressive patients (5-35 % for hospitalisation vs. 80 % for nursing home). Independent AD patients require 1-3 hours/day of caregiver time, while dependent patients can require up to 12-15 hours/day. Experts agreed that AD complicates the management of age-related comorbidities, found in 70-80 % of all AD patients, increasing the frequency and cost of hospitalisation. The Delphi panel approach was an efficient method of gathering data about the amount of healthcare resources used and associated costs for moderate and severe AD patients in urban China. The results of this study provide a useful source of information for decision makers to improve future healthcare policies and resource planning, as well as to perform economic evaluations of AD therapies.