Research paper
Burden-of-illness of Dutch community-dwelling older adults with sarcopenia: Health related outcomes and costs

https://doi.org/10.1016/j.eurger.2015.12.011Get rights and content

Abstract

Objective

To explore the burden-of-illness of Dutch community-dwelling older adults with sarcopenia, in terms of disability in activities of daily living (ADL), quality of life (QoL) and costs from a societal perspective.

Methods

The Maastricht Sarcopenia Study (MaSS) was performed in adults  65 y, receiving (1) no care, (2) home care/assisted living facility, or (3) care in a residential living facility. Sarcopenia was defined according to the European Working Group on Sarcopenia algorithm. Disability in ADL was measured with the Groningen Activity Restriction Scale (GARS); QoL with the EQ-5D-5L. Subjects were questioned about their health care use and health-related costs (societal perspective). Data are presented for sarcopenic and (age and sex matched) non-sarcopenic subjects. Bootstrapping was performed to estimate 95%CI around the mean costs. Several subgroup (age, sex, living situation, comorbidities) and sensitivity analyses were performed.

Results

Sarcopenic subjects (n = 53) scored significantly worse on health-related outcomes compared with non-sarcopenic subjects (n = 174; GARS 29 ± 11.3 vs. 22 ± 7.3, P < 0.001, QoL 0.78 ± 0.2 vs. 0.86 ± 0.2, P = 0.001). This difference was, except for the subscale ADL, no longer significant when compared with age and sex matched non-sarcopenic subjects (GARS 27 ± 10.6, P = 0.097, QoL 0.81 ± 0.2, P = 0.362). Mean health care costs of sarcopenic subjects (€4325, 95% CI: €3198–€5471) were significantly higher than those of non-sarcopenics (€1533, 95% CI: €1153–€1912), and higher, i.e. €1557 per three months (though not significant) compared with age and sex matched non-sarcopenics (€2768, 95% CI: €1914–€3743). Living situation (residential care) was a main driver of costs.

Conclusions

Community-dwelling sarcopenic older adults had a higher health and economic burden than non-sarcopenic older adults. This was importantly driven by the living situation – keeping older adults independent and out of care-dependent settings may contribute to a reduction of health care costs.

Introduction

Sarcopenia, the loss of muscle mass and function, is associated with poor health outcomes, such as a lower quality of life (QoL) and an increased risk of disability in activities of daily living (ADL), institutionalization and mortality [1], [2], [3], [4], [5]. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) suggested an algorithm to identify sarcopenia, based on low muscle mass in combination with poor strength or performance [6]. Using this algorithm, about 1–29% of the community-dwelling older adults and 14–33% of older adults living in a long-term care institution have sarcopenia [7].

In addition to being associated with negative health outcomes, sarcopenia could lead to a potential economic burden due to the related costs of disability, falls, institutionalization and comorbidities [8], [9]. Despite the fact that knowing the costs of a disease is important for policy makers [10], [11], only one study was found estimating the costs of sarcopenia in non-institutionalized adults aged  60 y [8]. This study defined sarcopenia as low muscle mass, and found that sarcopenia alone accounted for about 1.5% ($18.5 billions) of the direct total health care expenditures in the United States [8]. This equals about an extra $900 (about €677) per (sarcopenic) person per year. In that study, costs were indirectly calculated, using relative risk estimates of sarcopenia-related physical disability, previously reported costs of disability (from two national surveys conducted in 1980–1995) and previously reported prevalence rates of sarcopenia [8], [12]. They did not compare sarcopenic with (matched) non-sarcopenic older adults, and to the best of our knowledge, there are no studies that have measured actual health care costs in sarcopenic older adults in a European setting.

With an ageing population and the current pressure on health care systems and government budgets, it is relevant to get insight in the burden of sarcopenia in terms of health-related outcomes and costs. Early identification and management of sarcopenia (by e.g. resistance exercise combined with nutritional supplementation [13]) could reduce the impact of sarcopenia on both the individual (health related outcomes) as well as the society (costs of health care). Evidence for a substantial burden of disease strengthens the need for interventions and may support policy decisions with regard to prevention, diagnosis and treatment [10], [11].

The overall aim of this paper is to explore the burden-of-illness of Dutch community-dwelling older adults with sarcopenia, in terms of disability in ADL, quality of life, and costs, from a societal perspective. Older adults with sarcopenia were identified using the EWGSOP algorithm [6].

Section snippets

Methods

This manuscript follows the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and the Dutch guideline for costing research [14], [15].

Results

Of the 256 older adults who agreed to participate in the MaSS study and met the inclusion criteria, 9 subjects dropped out due to illness and 20 subjects were excluded from the analyses because of missing data for grip strength (n = 1) or cognitive function (n = 1), poor cognitive function (n = 8), invalid muscle mass measurement (n = 9) or both (n = 1). Therefore, the total analytical sample was 227.

Discussion

To aim of this study was to explore the burden-of-illness of Dutch community-dwelling older adults with sarcopenia, in terms of disability in ADL, QoL and costs, from a societal perspective. In this study, a higher health burden (in terms of disability in ADL and QoL) was seen in sarcopenic versus non-sarcopenic subjects. No evidence was found for a higher health burden in sarcopenic versus age and sex matched non-sarcopenic subjects, except for the subscale basic ADL. The total health care

Conclusions

Community-dwelling sarcopenic subjects had a higher health and economic burden than non-sarcopenic subjects. This was importantly driven by the living situation. Although differences in health and economic outcomes between sarcopenic and age and sex matched non-sarcopenic subjects were not significant, the same trend was seen. Keeping older adults independent and out of care-dependent settings may contribute to a reduction of health care costs.

Ethical statement

The MaSS study was approved by the Medical Ethics Committee of the Academic Hospital Maastricht and Maastricht University and registered at www.clinicaltrials.gov (NCT01820988).

Funding

This study was funded by Nutricia Research, Utrecht, the Netherlands.

Contributors

Study concept and design: R.H., J.M., J.S., S.E., Y.L., S.V., D.M. Data acquisition, statistical analyses and manuscript preparation: DM. Interpretation of data and critical revising: all. All authors read and approved the final manuscript.

Disclosure of interest

S.V. and Y.L. are employees of Nutricia Research.

The other authors declare that they have no competing interest.

Acknowledgments

We are grateful to all subjects of the MaSS study for their cooperation and Elles Lenaerts for her help with the data collection. We would like to thank Ruben Drost, Mitchel van Eeden and Mike Wallace for their advice with regard to the cost calculations and Frans Tan for his advice regarding the statistical analyses. The support of the municipality of Maastricht with the recruitment of subjects has been greatly appreciated.

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