NEJM：痴呆花费已超过癌症和心脏病

4月3日《新英格兰医学杂志》(New England Journal of Medicine)发表的一项研究显示，2010年，美国财政支出中痴呆的花费为1,590亿~2,150亿美元，使其成为较癌症或心脏病更大的财政负担。
加州圣塔莫尼卡市RAN老龄化研究中心主任Michael D. Hurd博士及其合作者使用健康和退休研究中的856例接受综合家庭临床痴呆评估的患者亚组，评估了美国的痴呆患病率和花费。研究者根据这些数据推算2000~2008年间所有70岁以上受试者的痴呆概率。估计社会痴呆花费的基础是每年每人的痴呆费用(41,000-56,000美元)，以及估计美国70岁以上老年人中痴呆患病率为14.7%(N. Engl. J. Med. 2013;368:1326-34)。
结果显示，2010年，美国财政支出中痴呆的花费为1,590亿~2,150亿美元。基于对看护者费用的估计，随着人口老龄化，预计到2040年这一数字将攀升至3,790亿~5,110亿美元。市场上痴呆治疗的直接花费已超过心脏病(1,020亿美元)或癌症(770亿美元)。多数痴呆相关费用为以家庭为基础的护理或长期护理机构提供的护理费用，而非其他医疗服务花费。
Hurd博士表示，新技术的使用为未来降低这些费用提供了可能性。例如，更好的远程医学可能减少长期护理机构中的人员配置。家庭辅助设备可能帮助看护者处理身体要求方面的工作。“即使我们未能证实医疗进步将延缓(痴呆的)发生，技术在降低医疗费用方面的作用可能也相当重要。”
研究者列出了多种费用数据，以反映从不同方面估计的无偿看护者提供的家庭护理的价值。在估计较高的情况下，对于无偿看护者费用的计算方式为确定从家庭式健康机构购买同等水平护理需要支付的费用。在较低的估计中，是基于看护者在劳动力市场上的价值。如果一位老年看护者已脱离工作岗位，则这一数值将很低。
该研究结论为，痴呆造成的社会经济负担已超过癌症和心脏病。提示政策制定者应加大对痴呆研究的投入。“痴呆确实在耗费我们的大量金钱，应该将一些资金投入到对这种疾病的探索和控制工作中。”
该研究得到国立衰老研究所(NIA)的一项基金资助，健康和退休研究是由密歇根大学进行的，并得到NIA和社会保障局提供的基金资助。
与痴呆相关的拓展阅读：

• 系统评价荟萃分析全球痴呆患病率
• Ann Intern Med：房颤增痴呆风险再添新证
• “双高”中年人患老年痴呆症风险同样升高（Whitehall II研究）
• JAMA：痴呆症非药物治疗六步走
• 韩国老年痴呆患者11年增至8倍 更多信息请点击：有关痴呆更多资讯

Monetary Costs of Dementia in the United States
Background
Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase.
Methods
In a subsample (856 persons) of the population in the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults, the diagnosis of dementia was determined with the use of a detailed in-home cognitive assessment that was 3 to 4 hours in duration and a review by an expert panel. We then imputed cognitive status to the full HRS sample (10,903 persons, 31,936 person-years) on the basis of measures of cognitive and functional status available for all HRS respondents, thereby identifying persons in the larger sample with a high probability of dementia. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers.
Results
The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95% confidence interval [CI], $42,746 to $69,834) or $41,689 (95% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost.
Conclusions
Dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer. (Funded by the National Institute on Aging.)