Indirect Costs of Alzheimer's Disease: Unpaid Caregiver Burden and Patient Productivity Loss.

Objectives: The direct medical costs associated with Alzheimer's disease (AD) in the United States have been estimated to be over $360 billion, but this value does not reflect the substantial financial burden on unpaid caregivers and society. We estimated the economic burden of unpaid caregivers and patient productivity loss due to AD across all disease severity stages to better understand the indirect impacts of AD.

Methods: We performed a narrative literature review to identify estimates of unpaid caregiver burden and market productivity loss. Additionally, we leveraged a published algorithm to estimate non-market productivity loss due to AD. Patient-level estimates were scaled to the population based on AD prevalence in the United States (approximately 12.5 million), weighted by disease severity.

Results: The total annual indirect costs of unpaid caregiving and of market and non-market productivity loss of AD increased with severity: $36,934 for mild cognitive impairment due to AD, $65,565 for Mild AD, $103,717 for Moderate AD, and $145,250 for Severe AD (2024 USD). Considering the current distribution of prevalent patients across severity stages, the total annual indirect cost was estimated at $832 billion, which includes $599 billion in unpaid caregiving costs and $233 billion in productivity losses.

Conclusions: Conventional cost estimates, which do not consider unpaid caregiver burden and patient productivity loss, significantly underestimate the total AD burden. Both elements should be incorporated into cost estimates and value assessments to best capture the total indirect impact of AD and the value of new therapies.