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2018 Conference Presentation

Demand measurement and projection The Netherlands

12 September 2018

The cost of frailty in the Netherlands

Bastian Ravesteijn, Universite Paris Descartes, The Netherlands

Thomas Rapp, Universite Paris Descartes


Background: Frailty among elderly individuals is associated with high risk of falls, disability, hospitalization, and mortality. Consequently, clinical interventions that reduce frailty could potentially prevent large downstream costs by keeping elderly in robust health.

Objectives: To estimate the costs and consequences of frailty.

Methods: We build a sample of elderly community-dwelling individuals in the Netherlands by linking two large surveys to five population-wide administrative data sources on household wealth, mortality, and curative and long-term care use. We use multivariate OLS regression methods and check for robustness of the results using alternative model specifications and estimation methods.

Results: Our estimates, based on our main analysis sample of 111,096 individuals aged 65 and older, suggest that 16.7 percent of the Dutch community-dwelling elderly are frail. The average cost of frailty, measured as the difference between robust and frail elderly of the sum of all in- and outpatient curative care services in 2012, plus the costs of nursing home admissions by 2014, was estimated at €6,099. The total cost of frailty among the Dutch community-dwelling elderly population was estimated at more than €1.5 billion. Additional analyses show that frailty in 2012 was associated with a 5.5-fold increase in the 2014 mortality rate compared with robustness, and that frailty was associated with substantially greater use of government-funded personal care, home care, and home nursing.

Conclusions: Our cost of frailty estimate should be interpreted as the lower bound on the potential savings from clinical interventions that reduce frailty.

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