Document Type


Publication Date



School of Pharmacy


Pharmaceutical Systems and Policy


Objective—To estimate the excess burden of out-of-pocket healthcare spending associated with Alzheimer’s disease and related disorders (ADRD) among older individuals (age ≥ 65 years). Methods—We adopted a retrospective, cross-sectional study design with data from 2012 Medicare Current Beneficiary Survey. The study sample comprised of elderly community dwelling individuals who had positive total healthcare expenditures, and enrolled in Medicare throughout the calendar year (462 with ADRD, and 7,160 without ADRD). We estimated the percapita total annual out-of-pocket spending on healthcare and out-of-pocket spending by service type: inpatient, outpatient, home health, prescription drugs, and other services. We measured outof-pocket spending burden by calculating the percentage of income spent on healthcare and defined high out-of-pocket spending burden as having this percentage above 10%. Multivariable analyses included ordinary least squares regressions and logistic regressions and these analyses adjusted for predisposing, enabling, need, personal healthcare practices and external environment characteristics. Results—The average annual per-capita out-of-pocket healthcare spending was greater among individuals with ADRD compared to those without ADRD ($3,285 vs. $1,895); home health and prescription drugs accounted for 52% of total out-of-pocket spending among individuals with ADRD and 34% among individuals without ADRD. Elderly individuals with ADRD were more likely to have high out-of-pocket spending burden (AOR = 1.49; 95% CI = 1.13, 1.97) compared to those without ADRD. Conclusion—ADRD is associated with excess out-of-pocket healthcare spending, primarily driven by prescription drugs and home healthcare use.

Source Citation

Dwibedi N, Findley PA, Wiener R C, Shen C, Sambamoorthi U. Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden Among Elderly Medicare Beneficiaries. Medical Care. January 2018:1. doi:10.1097/mlr.0000000000000869