Original ArticlesEvaluated Need, Costs of Care, and Payer Perspective in Degenerative Dementia Patients Cared for in the United StatesMurman, Daniel L. MD, MS*; Eye, Alexander Von PhD†; Sherwood, Paula R. RN, PhD‡; Liang, Jersey PhD§; Colenda, Christopher C. MD, MPH∥Author Information *Department of Neurological Sciences, University of Nebraska Medical Center, 982045 Nebraska Medical Center, Omaha, NE †Department of Psychology, Michigan State University, 119 Snyder Hall, East Lansing, MI ‡School of Nursing, University of Pittsburgh, 336 Victoria Bldg, 3500 Victoria Street, Pittsburgh, PA §Department of Health Management and Policy, University of Michigan, 1420 Washington Heights, Ann Arbor, MI ∥Office of the Dean, Texas A&M University System Health Sciences Center, 147 Joe H. Reynolds Medical Bldg., College Station, TX Sources of Support: The National Institute on Aging supported this work through grants K08-AG00864 for Dr Murman and P50-AG08671 for the Michigan AD Research Center. Reprints: Daniel L. Murman, MD, MS, Department of Neurological Sciences, University of Nebraska Medical Center, 982045 Nebraska Medical Center, Omaha, NE 68198-2045 (e-mail: firstname.lastname@example.org). Received for publication January 17, 2006; accepted October 16, 2006 Alzheimer Disease & Associated Disorders: January-March 2007 - Volume 21 - Issue 1 - p 39-48 doi: 10.1097/WAD.0b013e31802f2426 Buy Metrics Abstract The purpose of this study was to examine the strength of the associations between 5 measures of need that are potentially modifiable in degenerative dementia patients and direct costs of care from 5 payer perspectives in the US healthcare system. Data were derived from a cohort study of 150 patients with a degenerative dementia. We measured need variables at baseline and utilization of healthcare in the year before and after baseline. Utilization data were converted into estimated direct costs and totaled based on the costs paid for by 5 payers in the US healthcare system. Path models were used to quantify and compare the relationships between need variables and direct costs. From Medicare's perspective, comorbid medical conditions were the most important predictor of Medicare costs. From Medicaid's perspective, neuropsychiatric symptoms and signs of parkinsonism were additional significant predictors. From the perspective of patients, their families and society, all 5 need variables were significant predictors of direct costs (ie, those above, plus cognitive impairment, and dependency). The relationship between evaluated need variables and direct costs depends on the perspective of the payer and provide insights into which need variables could be targeted with interventions to control costs and improve patient outcomes. © 2007 Lippincott Williams & Wilkins, Inc.