Burden of illness among patients with dementia-related psychosis

Frazer, Monica; Abler, Victor; Halpern, Rachel; Skoog, Ben; Rashid, Nazia

doi:10.18553/jmcp.2021.27.3.367

Cited by 7 publications

(10 citation statements)

References 43 publications

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“…In a study of patients with probable Alzheimer’s disease, patients with a high Neuropsychiatric Inventory (NPI) score (i.e., more severe NPS) had formal and total direct costs USD 3000 to USD 6000 and USD 10,500 to USD 16,000 higher than patients with a low NPI score, and a one-point increase in NPI score was associated with an annual increase in total direct costs of USD 250 to USD 400 [ 5 ]. Our findings are also consistent with a recent report that patients with dementia-related psychosis were more likely to have diagnoses for behavioral health conditions and experience clinical events, and, consistently, had higher mean all-cause and dementia-related HCRU, relative to those with dementia only [ 27 ].…”

Section: Discussionsupporting

confidence: 92%

Economic Evaluation of Healthcare Resource Utilization and Costs for Newly Diagnosed Dementia-Related Psychosis

et al. 2022

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This retrospective cohort study described changes in all-cause healthcare resource utilization (HCRU) and associated costs in dementia patients newly diagnosed with psychosis. Dementia and incident psychosis were identified using diagnostic and pharmacy claims using a Medicare 20% random sample dataset. All-cause HCRU and unweighted and weighted (by person-years of follow-up) HCRU-associated costs were evaluated in the year prior to and the 4 years following diagnosis of psychosis. In 49,509 dementia patients with psychosis, physician visits per patient per year increased from a mean of 26.7 (standard deviation (SD) 20.0) prior to psychosis to 38.4 (SD 41.9) post-psychosis diagnosis. The number of inpatient stay claims increased from 1.0 (SD 1.4) to 1.7 (SD 5.8). Mean unweighted costs for inpatient stays and home healthcare/hospice during 2008–2016 were USD 9989 and USD 3279 prior to a diagnosis of psychosis but increased to USD 25,982 and USD 9901 (weighted: USD 11,779 and USD 6709), respectively, in the year after a psychosis diagnosis. This pattern of a sharp increase in mean costs was also observed in costs adjusted to 2015 USD, and in both unweighted and weighted total and psychosis-related costs. These results indicate the importance of identifying newly diagnosed psychosis in dementia patients as well as the pressing need for management strategies and treatments that can reduce HCRU and costs.

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Section: Discussionsupporting

confidence: 92%

Economic Evaluation of Healthcare Resource Utilization and Costs for Newly Diagnosed Dementia-Related Psychosis

et al. 2022

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“…Recent studies have reported that compared with older adults with dementia without psychosis, those with psychosis have more clinical events, such as falls and fractures, higher health care utilization, and higher mortality rates [7,11]. Given that dementia is composed of various dementia types, each with its own underlying etiology and disease trajectory, this current study describes the similarities and differences across the dementia types in the incidence of clinical events and treatment patterns after patients with dementia are diagnosed with psychosis.…”

Section: Discussionmentioning

confidence: 92%

Clinical outcomes and treatment patterns of older adults with dementia-related psychosis by dementia type in the United States

Forns

Danysh

McQuay

et al. 2022

Preprint

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Background Little is known about the incidence of clinical events and treatment patterns among older adults with dementia-related psychosis (DRP). Given that DRP is composed of various dementia types, this current study describes the similarities and differences across the dementia types in the incidence of clinical events and treatment patterns after patients with dementia are diagnosed with psychosis. Methods Adults aged ≥ 65 years and newly diagnosed with DRP were identified in US Medicare claims during 2013–2018. Baseline characteristics were evaluated at the time of the initial DRP diagnosis. After DRP diagnosis, for each dementia type (Alzheimer’s disease [AD], Parkinson’s disease dementia [PDD], dementia with Lewy bodies [DLB], frontotemporal dementia [FTD], vascular dementia [VD], and dementia, unspecified), incidence rates (IRs) of clinical events (e.g., falls/fractures, infections, healthcare utilization), mortality, and patterns of antipsychotic treatment were described. Daily mean cumulative counts were estimated to describe the potentially varying incidence of recurrent events over time. Mortality by time since DRP diagnosis was described using Kaplan-Meier survival curves. Results We identified 484,520 patients with DRP: mean age, 84 years; female, 66%. The most prevalent type of dementia at the index date was unspecified dementia (56%), followed by AD (31%), VD (12%), PDD (10%), DLB (3%), and FTD (< 1%). At the time of DRP diagnosis, most patients had scores on the Charlson Comorbidity Index (71%) and frailty index (62%) indicating severe illness. After DRP diagnosis, IRs (per 100 person-years) were high for emergency department visits, oral anti-infective use, and urinary tract infections for all dementia types. Overall, DLB was the dementia type with the highest incidence of clinical outcomes. After 1 year of follow-up, the cumulative probability of death was about 30% for all types of dementia. After 5 years of follow-up, the cumulative probability of death was about 80% among DRP patients with DLB, VD, AD, or PDD and about 60%-65% among patients with FTD or unspecified dementia Conclusions Patients with DRP had a high burden of comorbidities, frailty, emergency department visits, infections, and death. Specifically, after DRP diagnosis, patients with DLB and VD had the highest burden of clinical events of interest.

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“…Recent studies have reported that compared with older adults with dementia without psychosis, those with dementia-related psychosis have more serious risks, including falls and fractures, higher healthcare utilization, and higher mortality rates [7,17]. Specifically, the authors of a prior study conducted using Medicare claims from 2008 to 2016 found that patients with dementia-related psychosis had a hazard ratio of 2.4 (95% confidence interval [CI], 2.3-2.4) to enter in longterm care and a mortality hazard ratio of 2.1 (95% CI, 2.0-2.1) compared with those with dementia without psychosis [7].…”

Section: Open Accessmentioning

confidence: 99%

“…Specifically, the authors of a prior study conducted using Medicare claims from 2008 to 2016 found that patients with dementia-related psychosis had a hazard ratio of 2.4 (95% confidence interval [CI], 2.3-2.4) to enter in longterm care and a mortality hazard ratio of 2.1 (95% CI, 2.0-2.1) compared with those with dementia without psychosis [7]. Another study of patients with dementia who received commercial insurance or Medicare Advantage with Part D benefits during 2008 to 2018 found that a higher proportion of patients with psychosis experienced falls/fractures (psychosis group, 28%; no psychosis group, 14%) or cardiovascular effects (psychosis group, 7%; no psychosis group, 4%) compared with patients without psychosis [17].…”

Section: Open Accessmentioning

confidence: 99%

Clinical outcomes and treatment patterns of older adults with dementia-related psychosis by dementia type in the United States

Forns¹,

Danysh

McQuay

et al. 2022

BMC Geriatr

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Background Little is known about the incidence of clinical events and treatment patterns among older adults with dementia-related psychosis. Given that dementia-related psychosis comprises various dementia types, this study describes the incidence of clinical events and treatment patterns by dementia type after patients with dementia are diagnosed with psychosis. Methods Adults aged ≥ 65 years with dementia and newly diagnosed with psychosis were identified in US Medicare claims during 2013–2018. Baseline characteristics were evaluated at the time of the psychosis diagnosis. After the initial psychosis diagnosis, incidence rates (IRs) of clinical events (e.g., falls/fractures, infections, healthcare utilization), mortality, and patterns of antipsychotic treatment were described for each dementia type (Alzheimer’s disease [AD], Parkinson’s disease dementia [PDD], dementia with Lewy bodies [DLB], frontotemporal dementia [FTD], vascular dementia [VD], and unspecified dementia). Daily mean cumulative counts were estimated to describe the incidence of recurrent events over time. Mortality was described using Kaplan–Meier survival curves. Results We identified 484,520 patients with dementia-related psychosis: mean age, 84 years (standard deviation, 7.8); female, 66%. At the time of psychosis diagnosis, the most prevalent type of dementia was unspecified dementia (56%), followed by AD (31%), VD (12%), PDD (10%), DLB (3%), and FTD (< 1%), and most patients had scores indicating severe illness on the Charlson Comorbidity Index (71%) and frailty index (62%). Across all dementia types, IRs (per 100 person-years) were high for emergency department visits, oral anti-infective use, and urinary tract infections after the initial psychosis diagnosis. Patients with DLB had the highest incidence of most clinical outcomes. After 1 year of follow-up, the cumulative probability of death was about 30% for all dementia types, and after 5 years, was about 80% among patients with DLB, VD, AD, or PDD and about 60%-65% among patients with FTD or unspecified dementia. Conclusions Patients with dementia-related psychosis had a high burden of comorbidities, frailty, emergency department visits, infections, and death. Specifically, after DRP diagnosis, patients with DLB and VD had the highest burden of clinical events of interest.

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Burden of illness among patients with dementia-related psychosis

Cited by 7 publications

References 43 publications

Economic Evaluation of Healthcare Resource Utilization and Costs for Newly Diagnosed Dementia-Related Psychosis

Economic Evaluation of Healthcare Resource Utilization and Costs for Newly Diagnosed Dementia-Related Psychosis

Clinical outcomes and treatment patterns of older adults with dementia-related psychosis by dementia type in the United States

Clinical outcomes and treatment patterns of older adults with dementia-related psychosis by dementia type in the United States

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