Pre-Diagnosis Excess Acute Care Costs in Alzheimer’s Patients among a US Medicaid Population

Geldmacher, David S.; Kirson, Noam Y.; Birnbaum, Howard G.; Eapen, Sara; Kantor, Evan; Cummings, Alice Kate; Joish, Vijay N.

doi:10.1007/s40258-013-0038-9

Cited by 41 publications

(59 citation statements)

References 26 publications

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“…Our findings also showed that higher estimated costs in the first two years after diagnosis were preceded by significantly higher unadjusted costs among participants with dementia in the 12 months prior to diagnosis. Studies examining utilization and costs in the period before a dementia diagnosis have reported an increase in most measures of outpatient and inpatient utilization as well as costs beginning in the year prior to diagnosis . Higher costs in the prediagnosis period may result from a higher comorbidity burden among individuals with dementia and the concomitant challenges of managing comorbid conditions in the setting of cognitive impairment .…”

Section: Discussionmentioning

confidence: 99%

Medicare expenditures attributable to dementia

White

Fishman

Basu

et al. 2019

Health Services Research

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Objective To estimate dementia's incremental cost to the traditional Medicare program. Data Sources Health and Retirement Study (HRS) survey‐linked Medicare part A and B claims from 1991 to 2012. Study Design We compared Medicare expenditures for 60 months following a claims‐based dementia diagnosis to those for a randomly selected, matched comparison group. Data Collection/Extraction Methods We used a cost estimator that accounts for differential survival between individuals with and without dementia and decomposes incremental costs into survival and cost intensity components. Principal Findings Dementia's five‐year incremental cost to the traditional Medicare program is approximately $15 700 per patient, nearly half of which is incurred in the first year after diagnosis. Shorter survival with dementia mitigates the incremental cost by about $2650. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services. The incremental cost of dementia was about $7850 higher for females than for males because of sex‐specific differential mortality associated with dementia. Conclusions Dementia's cost to the traditional Medicare program is significant. Interventions that target early identification of dementia and preventable inpatient and post‐acute care services could produce substantial savings.

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Section: Discussionmentioning

confidence: 99%

Medicare expenditures attributable to dementia

White

Fishman

Basu

et al. 2019

Health Services Research

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“…People with MCD may utilise more GP services to seek help with symptoms of cognitive decline, but their higher usage may also be due to poorer management of comorbid conditions or having more accidents or injuries [12]. Previous research has hypothesised that the use of GPs may also be affected by participants' living arrangement, income or access to services [10,17].…”

Section: Discussionmentioning

confidence: 99%

“…Older adults with any MCD have more comorbid medical conditions, such as stroke, hypertension, diabetes mellitus [7,8,9] and cerebrovascular disease, than those without any MCD [10]. Mood disorders, such as anxiety or depression, have also been found to be more prevalent in people with cognitive impairment [8,11,12,13]. To prolong living within the community, individuals with cognitive or physical impairments may utilise more health services [5], particularly primary care.…”

Section: Introductionmentioning

confidence: 99%

“…Other research has found that, compared to controls, the frequency of GP contact increased in the 2-5 years prior to dementia diagnosis [9,20]. The cost and use of healthcare services was noticeably higher in the year prior to dementia diagnosis compared to controls [9,12]. The total medical cost over 1 year was USD 5,549 more for prediagnosed Alzheimer's disease patients than controls [12], and Alzheimer's disease patients had an average of 6.6 GP visits whereas controls had 3.8 [9].…”

Section: Introductionmentioning

confidence: 99%

“…The cost and use of healthcare services was noticeably higher in the year prior to dementia diagnosis compared to controls [9,12]. The total medical cost over 1 year was USD 5,549 more for prediagnosed Alzheimer's disease patients than controls [12], and Alzheimer's disease patients had an average of 6.6 GP visits whereas controls had 3.8 [9]. Other research has found no association between cognitive decline and contact with a GP [5,19,21].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Longitudinal Analysis of General Practitioner Service Use by Patients with Mild Cognitive Disorders in Australia

Butterworth¹,

Anstey²

2016

Dement Geriatr Cogn Disord

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Background: The aim of this study was to ascertain if participants diagnosed with any mild cognitive disorder (MCD) visited a general practitioner (GP) more than those without MCD and the effect of either depression or arthritis on GP use longitudinally. Methods: 2,551 participants aged 60-64 years at baseline completed the Personality and Total Health Through Life (PATH) study in Canberra. Follow-up data were collected after 4 and 8 years. A cognitive screening battery was used to screen participants into a substudy of MCD. Results: Participants with any MCD had greater GP use than cognitively healthy participants across all three waves (wave 1, M = 7.35 vs. 5.59; wave 2, M = 7.77 vs. 5.86; wave 3, M = 9.01 vs. 6.81). After adjusting for demographic and health factors, MCD was a significant predictor of GP use at all three waves (p < 0.05, CI 0.84-0.99). Conclusion: This study has shown that MCD is associated with a higher use of GP visits, especially if the patient has a comorbid condition.

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2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

1,962

653

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid‐century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.

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Pre-Diagnosis Excess Acute Care Costs in Alzheimer’s Patients among a US Medicaid Population

Cited by 41 publications

References 26 publications

Medicare expenditures attributable to dementia

Medicare expenditures attributable to dementia

A Longitudinal Analysis of General Practitioner Service Use by Patients with Mild Cognitive Disorders in Australia

2020 Alzheimer's disease facts and figures

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