Informatics Research Seminar: Health Economics: Using Medicare Data to Estimate Cost of Dementia at End of Life

March 2 @ 4:00 – 5:00 PM


Speaker: Vicki L. Lamb, PhD
Presented from NCCU

Broadcast Link: Seminar



This presentation summarizes a study using Medicare data to estimate costs of dementia vs. non-dementia people at the end of life. In 2008, Dr. Vicki Lamb, NCCU, worked with Dr. Frank Sloan, a health economist at Duke. They used a co-variate matching or propensity analysis during their study. The research applied a data analytics technique that is becoming more widespread today.

The study’s objective was to determine the effect of a diagnosis of Alzheimer’s disease or related dementias (ADRD), and the timing of first ADRD diagnosis on Medicare expenditures at the end of life. The presentation will describe research methods and results. The data extraction methods involved Medicare payment data for the 5 years before death, which were used to compare 5-year and 6-month intervals of expenditures (total and six subcategories of services) for persons with and without a diagnosis of ADRD during the last 5 years of life. Covariate matching was used. The principal findings were that on average, ADRD diagnosis was not significantly associated with excess Medicare payments over the last 5 years of life. However, payment differences by 6-month intervals were highly sensitive to timing of ADRD diagnosis, with the highest differences occurring around the time of diagnosis.  Only those diagnosed with ADRD in the last year of life had significantly higher Medicare payments during the last 12 months of life, primarily for acute care services.

Dr. Lamb will summarize study and conclusions including that ADRD has a smaller impact on total Medicare expenditures than previously reported in controlled studies. Although rates of dementia are increasing per se, the research team’s results suggest that long-term (11 year) ADRD diagnoses do not contribute to greater total Medicare costs at the end of life.

Speaker Bio

Dr. Vicki Lamb, PhD., is a professor of sociology and human studies. She is currently in the department of Human Sciences, where she serves as director of graduate studies, at North Carolina Central University. Her long-term interests have been in the demography of aging, quantitative research methodologies, and the health and disability of older persons. During her PhD Studies at Duke University, she was supported by an NIH/NIA pre-doctoral fellowship in medical demographic and epidemiology of aging. Dr. Lamb’s dissertation was a comparative study of fuzzy-set patterns of health and disability among persons age 60 and older in 13 less-developed countries. Later she received an NIH/NIA R03 grant to study the effects of Meals-on-Wheels programs on Nursing Home entry. She also worked with Dr. Frank Sloan, health economist at Duke, to examine end-of-life Medicare costs for demented and non-demented persons, which is the subject of her talk. She is also interested in children and youth and has worked with Dr. Kenneth Land, Duke Sociology Professor, since 1999 on a Child and Youth Well-Being Index Project.  She has published over 60 articles and book chapters on research using methods such as fuzzy-sets, propensity analysis, survival modeling, hierarchical linear modeling and time-series analysis. She‘s been a principal/co-investigator on over 20 grant-funded projects.