Cost of Dementia in India

1. Cost of Dementia in India SrikalaBharath & GirishN. Rao1 NIMHANS, India Dr. SrikalaBharathDPM, MD, DC,AP FRCPsych Professor of Psychiatry, srikala.bharath@gmail.com 1Dr. Girish N. Rao, MD Associate Prof Epidemiology NIMHANS, Bangalore, India

2. Disclosure • No Conflicts of Interest Srikala Bharath, India Cost of Dementia, ADI 2012

3. Dementia – so what? DEMENTIA IS A CONDITION OF THE ELDERLY INDIA IS GRAYING RAPIDLY Srikala Bharath, India Cost of Dementia, ADI 2012

4. AGE PYRAMID Srikala Bharath, India Cost of Dementia, ADI 2012

5. New estimates for India millions 12.5 6.4 3.7 Az Srikala Bharath, India Cost of Dementia, ADI 2012

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8. Cost of Illness • Direct Cost – Medical and Non Medical (social) • Indirect cost – Loss of Productivity, Wages, Transportation etc • Intangible cost – Suffering, Pain etc Direct Cost - Out of Pocket Cost (OOPs) Srikala Bharath, India Cost of Dementia, ADI 2012

9. Cost of Dementia • WHY ASSESS COD? • Provides the Economic Burden of Dementia • Informed Choices can be made by the government about priorities in Elderly - Which Health issues to be addressed - Which interventions work - Policies /Program Srikala Bharath, India Cost of Dementia, ADI 2012

10. Earlier Estimates Wimo et al (2010) Alz & Dementia Cost in 2009 • Based on prevalence, country specific GDP per person, average wage, Purchase Power Parity (PPP), available COD studies from different countries. • 34.4 million PwD. • $ 422 million in 2009 • $ 142 million for informal care (34%) • Depending on quantum of Informal care (1.6 hrs/ day or 3.7 hrs/day) the cost varied from $142 to 329 million. • An increase of 34% in the cost from 2005 to 2009 incl. 18% increase in fixed costs. • 77% of the cost is from more developed regions (MDR) with 46% prevalence. Srikala Bharath, India Cost of Dementia, ADI 2012

11. Cost of Dementia Care in IndiaWimo et al 2010 • Readjusted total societal cost of Dementia • US$ 9.4 to 13.7 million / INR 451 to 657 billion • Direct costs USD 6.1 million /INR 292 billion • Informal care 34 % 56% • Annual cost / person • US$ 2, 295 (INR 96,850) to USD 5061 (INR 263,350) Srikala Bharath, India Cost of Dementia, ADI 2012

12. Methodology • Desk work using a naturalistic approach. • Different components of care for PwD comprehensively listed out during the brain storming session • Cost the individual components of care: • experience and expert guesstimates. • Consensus on relative priority for care components • Modified after feedback from families/ care providers • Life cycle approach adopted to calculate life time costs of care for a PwD Srikala Bharath, India Cost of Dementia, ADI 2012

13. Realities Expenses incurred by 3 different persons • A person taken care by professional carers round the clock at home in a city Rs. 14,000 p.m. • A person with AD who is staying in an old age home in Chennai Rs. 9,000 p.m • A person staying in a small town and taken care of by semi-trained carers Rs. 8,000 p.m. Srikala Bharath, India Cost of Dementia, ADI 2012

14. Assumptions • Prevalence of dementia taken to be 3.69 million • PwD were functionally classified depending on need for care and or medical attention: • Mild (30% of all PwD) need care and medical attention of some level greater than a normal elderly; • Moderate (60% of all PwD) need extra care and medical attention; • Severe (10% of all PwD) need special care all time around and medical attention. • Survival of PwD was assumed to be 5 years, 3 years and 2 years for mild, moderate and severe cases respectively. • The human capital value to estimate cost of care-giving. • Over the counter rates of medication (cognitive enhancers and anti-psychotics) of common Indian brands were enquired before assigning the costs of medications. Srikala Bharath, India Cost of Dementia, ADI 2012

15. Needs, Components & Assumptions Srikala Bharath, India Cost of Dementia, ADI 2012

16. Needs, Components & Assumptions Note: 1) -,, +, ++, +++ indicates the priority from lowest to highest 2) Applicability is the proportion of PwDs needing that particular service Srikala Bharath, India Cost of Dementia, ADI 2012

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20. Projections • Over a 10 year period, (after diagnosis, being as mild dementia for 5 years, moderate dementia as 3 years and severe dementia as 2 years), the total cost for an individual household would be nearly Rs 1.3 million. • Compared to 2010, with average annual inflation of 10%, the costs would • more than double by 2025 • increase five-fold by 2045 • seven times by 2050 Srikala Bharath, India Cost of Dementia, ADI 2012

21. Take home messages • A comprehensive estimate • Realistic estimate • Household costs calculated • Several unanswered questions • Most importantly what next????? Srikala Bharath, India Cost of Dementia, ADI 2012

22. Work in the Geriatric Services, NIMHANS • Household Burden of Dementia – cross sectional enquiry of 100 families with persons with dementia on their OOPS • Cost of Dementia – a prospective study of 250 families over one year on their OOPS in persons with dementia in comparison to elderly with severe mental illness. • Both initiated in 2011 Srikala Bharath, India Cost of Dementia, ADI 2012

23. Thank you • Acknowledgements : Dr. GirishRao, Assoc. Prof Epidemiology, NIMHANS, Prof. M. Varghese, Dr. Sivakumar PT, Dept Psychiatry, NIMHANS, Geriatric Group • Sanofi India – for new initiatives • Families of PwD and members of ARDSI Srikala Bharath, India Cost of Dementia, ADI 2012