Projection of budgetary savings to US state Medicaid programs from reduced nursing home use due to an Alzheimer's disease treatment

Abstract

Introduction The approval of a disease‐modifying Alzheimer's disease (AD) treatment could provide relief to US state budgets that were hit hard by the COVID‐19 pandemic, as mostly Medicare would cover treatment cost, whereas Medicaid would see savings from reduced nursing home use. Methods We project savings from 2021 to 2040 with a simulation model from the perspective of state Medicaid programs. Results Assuming a 40% and 22% relative reduction of disease progression rates with treatment, Medicaid would avoid payments of $186.2 and $93.5 billion for around 1.11 and 0.57 million nursing home patient‐years, respectively. The savings correspond to a 5.06% and 2.49%, respectively, relative reduction of Medicaid spending on nursing home care. Higher per capita savings were projected for older states, those with higher Medicaid payment rates, those with more nursing home residents covered by Medicaid, and those with a lower federal contribution. Discussion States stand to realize substantial savings from a potential AD treatment. A state's health system preparedness to handle the large number of patients will influence the actual magnitude of the savings and how fast they will accrue.

Projecting the long‐term societal value of a disease‐modifying treatment for Alzheimer's disease in the United States

“…The evolution of patients across stages, in turn, determines our outcomes, like mortality, medical cost, and caregiver burden. Details for these two parts have been previously published 19,20 …”

“…As access to treatment is likely to be constrained by the existing capacity to diagnose, 1 we project what proportion of societal value will be realized with a previously published model. 19 We use two assumptions on how patients will be identified in primary care settings and referred to a dementia specialist for further evaluation. The first is that referrals are based on a positive Mini‐Mental State Examination (MMSE) test alone, the second that a blood test for the AD pathology is conducted in patients with a positive MMSE and patients are only referred if both tests are positive.…”

“…Details for these two parts have been previously published. 19,20 The third part computes the differences in outcomes between the treatment and no-treatment groups and projects the effects of changing the disease progression on the included elements of the value flower, as detailed under the description of those elements. Sources, values, and distributions for all parameters can be found in the Technical Appendix in supporting information.…”

The Case for a Novel Therapeutic Approach to Dementia: Small Molecule Hepatocyte Growth Factor (HGF/MET) Positive Modulators

“…Further, a program designed to improve caregiver well-being reduced nursing home placement of persons with AD [ 20 ]. A model of the effect of reduced nursing home use with effective treatments for AD projected billions of dollars saved for reduced nursing home placement [ 21 ]. Another study of societal benefits from a treatment that slowed disease progression by 30% projected a reduction in costs of $5 trillion over 20 years in the US [ 22 ].…”

Expected wait times for access to a disease‐modifying Alzheimer's treatment in the United States

“…In addition, better data became available since the original study, such as on incidence of mild cognitive impairment (MCI), 5 share of amyloid-positive MCI patients, 6 and number of PET scanners and dementia specialists in the United States. 7 The emergence of bloodbased biomarkers for Alzheimer's pathology 8 has the potential to improve triage at the primary care level and thus reduce downstream wait times. 9 In light of the approval of aducanumab in the United States, we are re-investigating the country's preparedness with an improved simulation model.…”