1. Cost of Dementia in India
Srikala Bharath & Girish N. Rao1
NIMHANS, India
Dr. Srikala Bharath DPM, MD, DC,AP FRCPsych
Professor of Psychiatry,
1Dr. Girish N. Rao, MD
Associate Prof Epidemiology
NIMHANS, Bangalore, India

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

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

4. Srikala Bharath, India Cost of Dementia, ADI 2012
AGE PYRAMID
                                                                                                                                                                                                                                                                                                           
                                                                                                                                                                                                                                                                                       
77 million in million currently 177 in 2050
Srikala Bharath, India Cost of Dementia, ADI 2012

5. New estimates for India
millions
12.5
6.4
ADI commissioned a group of researchers to review the available epidemiological estimates, and come up with consensus estimates of the prevalence of dementia in all world regions, from which a total number of cases worldwide could be calculated2.2 Million of Women and 1.5 Million of Men
3.7 Az
Srikala Bharath, India Cost of Dementia, ADI 2012

6. Srikala Bharath, India Cost of Dementia, ADI 2012

7. Srikala Bharath, India Cost of Dementia, ADI 2012

8. Srikala Bharath, India Cost of Dementia, ADI 2012
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. Srikala Bharath, India Cost of Dementia, ADI 2012
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. Srikala Bharath, India Cost of Dementia, ADI 2012
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.
Wimo did the following. Looked at all available economics of Dementia care in the various countries. Converted them into hours of care. Calculated Direct Cost and Informal Care.
Srikala Bharath, India Cost of Dementia, ADI 2012

11. Cost of Dementia Care in India Wimo 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)
According to them the actual cost now in India is $ million (INR 147 billion) 2/3 informal care. 29% is direct medical cost and cost PwD $925 (INR 43, 285 /pa)
Srikala Bharath, India Cost of Dementia, ADI 2012

12. Srikala Bharath, India Cost of Dementia, ADI 2012
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
2 epidemiologists, one social worker, 4 psychiatrists
Srikala Bharath, India Cost of Dementia, ADI 2012

13. Srikala Bharath, India Cost of Dementia, ADI 2012
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. Srikala Bharath, India Cost of Dementia, ADI 2012
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
Components and assumptions for costs
Need and Applicability
Mild
Mod
Severe
Medical Consultation
++;
100%
+++; 100%
2. Medication
50%
3. Lost Productivity
4. Informal Care Giving
- ;
+++;
5. Paid care / residential care by health aide- NA 
60% HIC 30% MIC
75% HIC 25% MIC
Srikala Bharath, India Cost of Dementia, ADI 2012

16. Needs, Components & Assumptions
Components and assumptions for costs
Need and Applicability
Mild
Mod
Severe
6. Hospitalization
- ;
Not expected +;
10%
++;
20%
7. Day Care NA
8. Special Food
33%
75%
9. House Modification
50%
+++;
100%
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

17. Srikala Bharath, India Cost of Dementia, ADI 2012
Particulars
Severity of Dementia
Mild
Moderate
Severe
1)     Medication
3,600
18,000
2,700
2)     Consultation
1,700
3)     Investigation (one time)
3,000
4)     Hospitalisation
2,000
4,000
5)     Transportation
1,200
800
6)     Paid / Residential care
27,600
1,05,000
7)     Day care
9,600
19,200
8)     Lost Productivity
36,000
48,000
60,000
9)     Informal Care (Opportunity Lost)
12,000
10) Special food
2,970
20,250
11) House modification (one time)
2,500
3,750
5,000
Srikala Bharath, India Cost of Dementia, ADI 2012

18. TOTAL for all PwD in India INR 500,279 million (house hold cost)
Particulars
Severity of Dementia
Mild
Moderate
Severe
TOTAL cost per person
69,600
1,51,420
2,38,450
PwD (in millions)
1.107
2.214
0.369
Overall cost (in millions)
77,047
335,244
87,988
TOTAL for all PwD in India INR 500,279 million (house hold cost)
Srikala Bharath, India Cost of Dementia, ADI 2012

19. Srikala Bharath, India Cost of Dementia, ADI 2012
Particulars
Severity of Dementia
Mild
Moderate
Severe
Direct medical care
11.9%
16.3%
4.8%
Direct social care
15.5%
25.4%
38.1%
Informal care
72.6%
58.3%
57.1%
Srikala Bharath, India Cost of Dementia, ADI 2012

20. Srikala Bharath, India Cost of Dementia, ADI 2012
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. Srikala Bharath, India Cost of Dementia, ADI 2012
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. Srikala Bharath, India Cost of Dementia, ADI 2012
Thank you
Acknowledgements : Dr. Girish Rao, 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