Pharmaceutical Treatment for Alzheimer’s Disease and Related Dementias: Utilization and Disparities

Article type: Research Article

Authors: Barthold, Douglas^{a; *} | Joyce, Geoffrey^b | Ferido, Patricia^c | Drabo, Emmanuel F.^d | Marcum, Zachary A.^a | Gray, Shelly L.^a | Zissimopoulos, Julie^c

Affiliations: [a] The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA | [b] School of Pharmacy, Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA | [c] Price School of Public Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA | [d] Health Policy and Management Department, Johns Hopkins University, Baltimore, MD, USA

Correspondence: [*] Correspondence to: Douglas Barthold, UW Department of Pharmacy, 1959 Pacific St NE, Box 357630, Seattle, WA 98107, USA. Tel.: +1 781 264 3267; E-mail: [email protected].

Abstract: Background:Four prescription drugs (donepezil, galantamine, memantine, and rivastigmine) are approved by the US FDA to treat symptoms of Alzheimer’s disease (AD). Even modest effectiveness could potentially reduce the population-level burden of AD and related dementias (ADRD), especially for women and racial/ethnic minorities who have higher incidence of ADRD. Objective:Describe the prevalence of antidementia drug use and timing of initiation relative to ADRD diagnosis among a nationally representative group of older Americans, and if there are disparities in prevalence and timing by sex and race/ethnicity. Methods:Descriptive analyses and logistic regressions of Medicare claims (2008–2016) for beneficiaries who had an ADRD or dementia-related symptom diagnosis, or use of an FDA approved drug for AD. We investigate prevalence of use and timing of treatment initiation relative to ADRD diagnosis across time and beneficiary characteristics (age, sex, race/ethnicity, socioeconomic status, comorbidities). Results:Among persons diagnosed with ADRD or related symptoms, 33.3% used an approved drug over the study period. Odds of use was higher among Whites than non-Whites. Among ADRD drug users, 40% initiated use within 6 months of the initial ADRD or related symptoms diagnosis, and 16% initiated prior to a diagnosis. We observed disparities by race/ethnicity: 28% of Asians, 24% of Hispanics, 16% of Blacks, and 15% of Whites initiated prior to diagnosis. Conclusions:The use of antidementia drugs is relatively low and varies widely by race/ethnicity. Heterogeneity in timing of initiation and use may affect health and cost outcomes, but these effects merit further study.

Keywords: Acetylcholinesterase inhibitors, Alzheimer’s disease and related dementias, disparities, donepezil, galantamine, memantine, rivastigmine

DOI: 10.3233/JAD-200133

Journal: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 579-589, 2020