(81) The Global Societal Burden of Alzheimer’s Disease by Severity: A Targeted Literature Review

Background: : Alzheimer’s disease (AD) is among the costliest of illnesses for the elderly and is increasingly straining healthcare systems and caregivers alike. Previous reviews fail to present a comprehensive perspective, overlooking the nuanced interplay, and totality of, unmet medical needs.

Objective: : To characterize the total societal burden of AD by care setting and disease severity.

Methods: : A targeted literature search of systematic reviews, cost-of-illness, and observational studies published between 2013 and 2024 was conducted on MEDLINE and Embase to identify articles reporting the economic burden of AD. Grey literature was hand-searched. Both direct and indirect costs were assessed, including societal burdens not often reported by AD-specific cost-of-illness studies such as financial delinquencies.

Results: : A total of 81 articles were reviewed, including 20 systematic reviews and 61 studies or reports. Most studies focused on community-dwelling (41%) or mixed care settings (40%). More than 70% of studies reported costs separately by disease stage, with 23% addressing patients with MCI. Findings consistently showed that the societal costs of AD increased significantly with advancing disease stages, with some variations across regions (Europe: 32%-150%; North America: 29%-67%; Asia: 34%-144%). Direct costs also rose with disease progression, with non-medical expenses (e.g., social care, home assistance, institutionalization), increasing disproportionately compared to medical costs. This review identified direct costs that are unique to AD, such as additional heating bills due to limited mobility (additional ₤118-₤913 PPY) and costs related to police call outs to find lost and wandering individuals with AD (₤7-₤48 PPPY). Indirect costs, particularly informal caregiving, accounted for approximately half of total societal costs, regardless of care setting, disease severity, region, or cost calculation method. Across studies, caregivers were predominantly female, retired, and often the spouses of patients. Where reported, the average number of caregivers per patient ranged from 1.60 to 2.62 for those with MCI or AD, increasing as disease progressed. Informal caregiving was sometimes reported to exceed 30 hours per week for mild disease, reaching up to 120 hours per week in severe disease, and remained a substantial burden even in institutionalized settings.

Conclusions: : This review offers a comprehensive analysis, drawing from studies conducted over more than a decade, to illustrate the significant societal economic burden AD across care settings, cost categories, disease stages, and regions.

Sponsorship:: Eisai Inc.