Healthcare utilization and economic costs of neurocognitive disorders in community-dwelling older Chinese adults: A comparison with 9 Asian economies

Background It is increasing recognized that care for people with neurocognitive disorders (NCDs) is costly, and cost of NCDs can be highly context dependent. Objective To evaluate the healthcare utilization and economic costs of NCDs in Hong Kong, cross referencing with other Asian metropolitan cities. Methods 461 older adults aged ≥60 (major NCD: 68, mild NCD: 264, normal cognition: 129) were recruited from a population-based cross-sectional survey, Hong Kong Mental Morbidity Survey for Older People. Healthcare utilization was collected by Resource Utilization of Dementia. Per person cost was estimated from a societal perspective and expressed in 2022 US dollars. Cost-associative factors were explored. Our findings were compared to cost-of-illness evidence in major Asian metropolitan cities by a systematic review. Results Annual costs per community-living adult with mild and major NCD were US$5677 (95%CI: 4985–6465) and US$12,841 (9940–16,590) in Hong Kong. For those with major NCD, costs doubled in severer stages, and diagnosed cases incurred nearly 30% more costs than hidden cases. Dementia cost in Hong Kong was lower than other high-income Asian economies and mainland China, mainly due to methodological heterogeneities and lower utilization of social care services. Conclusions The great economic burden of NCDs in Hong Kong reflects a striking social and care needs, particularly in moderate and severe stages. Care planning should prepare for the blowout needs being revealed by hidden cases and the diversified needs by different stages and family caregivers. Region- and population-specific studies with rigor design are warranted to estimate cost-effectiveness of upcoming treatment strategies.