Economic Burden, Mortality, and Institutionalization in Patients Newly Diagnosed with Alzheimer’s Disease

Article type: Research Article

Authors: Black, Christopher M.^{a; *} | Fillit, Howard^b | Xie, Lin^c | Hu, Xiaohan^d | Kariburyo, M. Furaha^c | Ambegaonkar, Baishali M.^a | Baser, Onur^{e; f} | Yuce, Huseyin^g | Khandker, Rezaul K.^a

Affiliations: [a] Merck & Co., Inc., Kenilworth, NJ, USA | [b] The Icahn School of Medicine at Mount Sinai, and the Alzheimer’s Drug Discovery Foundation, New York, NY, USA | [c] STATinMED Research, Ann Arbor, MI, USA | [d] University of Southern California, Los Angeles, CA, USA | [e] Department of Surgery, Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA | [f] STATinMED Research, New York, NY, USA | [g] New York City College of Technology (CUNY), New York, NY, USA

Correspondence: [*] Correspondence to: Christopher M. Black, MPH, Associate Director, Immunology & Neuroscience, Center for Observational and Real-World Evidence (CORE), 126 E. Lincoln Ave., Mailstop: RY32-211, Rahway, NJ 07065, USA. Tel.: +1 732 594 3037; E-mail: [email protected].

Abstract: Background:Current information is scarce regarding comorbid conditions, treatment, survival, institutionalization, and health care utilization for Alzheimer’s disease (AD) patients. Objectives:Compare all-cause mortality, rate of institutionalization, and economic burden between treated and untreated newly-diagnosed AD patients. Methods:Patients aged 65–100 years with ≥1 primary or ≥2 secondary AD diagnoses (ICD-9-CM:331.0] with continuous medical and pharmacy benefits for ≥12 months pre-index and ≥6 months post-index date (first AD diagnosis date) were identified from Medicare fee-for-service claims 01JAN2011–30JUN2014. Patients with AD treatment claims or AD/AD-related dementia diagnosis during the pre-index period were excluded. Patients were assigned to treated and untreated cohorts based on AD treatment received post-index date. Total 8,995 newly-diagnosed AD patients were identified; 4,037 (44.8%) were assigned to the treated cohort. Time-to-death and institutionalization were assessed using Cox regression. To compare health care costs and utilizations, 1 : 1 propensity score matching (PSM) was used. Results:Untreated patients were older (83.85 versus 81.44 years; p < 0.0001), with more severe comorbidities (mean Charlson comorbidity index: 3.54 versus 3.22; p < 0.0001). After covariate adjustment, treated patients were less likely to die (hazard ratio[HR] = 0.69; p < 0.0001) and were associated with 20% lower risk of institutionalization (HR = 0.801; p = 0.0003). After PSM, treated AD patients were less likely to have hospice visits (3.25% versus 9.45%; p < 0.0001), and incurred lower annual all-cause costs ($25,828 versus $30,110; p = 0.0162). Conclusion:After controlling for comorbidities, treated AD patients have better survival, lower institutionalization, and sometimes fewer resource utilizations, suggesting that treatment and improved care management could be beneficial for newly-diagnosed AD patients from economic and clinical perspectives.

Keywords: Alzheimer’s disease, institutionalization, Medicare, mortality

DOI: 10.3233/JAD-170518

Journal: Journal of Alzheimer's Disease, vol. 61, no. 1, pp. 185-193, 2018