The Clinical and Economic Burden of Newly Diagnosed Alzheimer’s Disease in a Medicare Advantage Population

Suehs, Brandon T.; Davis, Cralen; Alvir, José; Amerongen, Derek van; Patel, Nick C.; Joshi, Ashish V.; Faison, Warachal; Shah, Sonali

doi:10.1177/1533317513488911

Cited by 64 publications

(74 citation statements)

References 36 publications

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“…A consistent finding of all studies comparing individuals with and without ADRD is that the average medical, nonmedical, and indirect costs of individuals with ADRD are higher than those of individuals without ADRD [6,7,12,15,18–21], despite the differences in source of payment (Medicare, Medicaid, out-of-pocket), time period (lifetime vs. annual) and study population (e.g. decedents vs. all adults, AD vs. all forms of dementia), and stage of disease.…”

Section: Expert Commentarymentioning

confidence: 76%

“…Similar pattern was observed in another study using Medicare Advantage Prescription Drug plan dataset. This study revealed that during the year prior to diagnosis of ADRD, total medical expenditures were 44% higher, 1 year after diagnosis, the total medical expenditures were 2 times higher, and 2 years after diagnosis, the total medical expenditures were 1.7 times higher in the AD versus non-AD cohort [12]. In addition, the perceptions of physicians, patients, and family members regarding ADRD may also affect health-care utilization following an ADRD diagnosis.…”

Section: Economic Burden Of Adrd: Direct Medical Nonmedical and mentioning

confidence: 99%

See 1 more Smart Citation

Direct and indirect cost of managing alzheimer’s disease and related dementias in the United States

Deb

Thornton

Sambamoorthi

et al. 2017

Expert Review of Pharmacoeconomics & Outcomes Research

140

113

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Introduction Care of individuals with Alzheimer’s Disease and Related Dementias (ADRD) poses special challenges. As the disease progresses, individuals with ADRD require increasing levels of medical care, caregiver support, and long-term care which can lead to substantial economic burden. Areas covered In this expert review, we synthesized findings from studies of costs of ADRD in the United States that were published between January 2006 and February 2017, highlighted major sources of variation in costs, identified knowledge gaps and briefly outlined directions for future research and implications for policy and program planning. Expert commentary A consistent finding of all studies comparing individuals with and without ADRD is that the average medical, non-medical, and indirect costs of individuals with ADRD are higher than those without ADRD, despite the differences in the methods of identifying ADRD, duration of the study, payer type and settings of study population. The economic burden of ADRD may be underestimated because many components such as direct non-medical costs for home safety modifications and adult day care services and indirect costs due to the adverse impact of ADRD on caregivers’ health and productivity are not included in cost estimates.

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Section: Expert Commentarymentioning

confidence: 76%

Section: Economic Burden Of Adrd: Direct Medical Nonmedical and mentioning

confidence: 99%

Direct and indirect cost of managing alzheimer’s disease and related dementias in the United States

Deb

Thornton

Sambamoorthi

et al. 2017

Expert Review of Pharmacoeconomics & Outcomes Research

140

113

View full text Add to dashboard Cite

show abstract

“…These findings are similar to those from earlier studies that reported higher healthcare resource utilization and costs for individuals with Alzheimer's disease and dementia when compared with individuals without these conditions. [31][32][33][34] Individuals diagnosed with dementia are more likely to also be diagnosed with other comorbidities, 35 and to report greater difficulties in instrumental activities of daily living. 36 As a result, individuals with dementia may tend to use more LTC services and therefore incur higher LTC expenditure than non-dementia individuals.…”

Section: Discussionmentioning

confidence: 98%

The determinants of long-term care expenditure and their interactions

Lin

Otsubo

Sasaki

et al. 2016

International Journal of Healthcare Management

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Objective: A cross-sectional study was conducted to examine the factors associated with long-term care (LTC) expenditure among LTC service users in Kyoto Prefecture, Japan. Method: Using descriptive statistics and multiple linear regression analysis, we investigated the associations of gender, dementia, service type, and other factors with LTC expenditure. Result: Our regression analysis showed that older age, women, and higher care needs levels were significantly associated with higher LTC expenditure. Furthermore, women who used home care and community-based/other care services had higher expenditures than men who used the same services. In contrast, men who used facility care services had higher expenditures than women. Service users with dementia were also found to be significantly associated with higher LTC expenditure. Conclusion: There is a need for policy interventions that focus on gender differences and dementia when developing care service plans to ensure the sustainability of the LTC system.

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“…AD affects approximately 5.4 million individuals in the United States and is estimated to affect up to 16 million by 2050 [33]. In Western countries, AD is the most prevalent form of dementia (45-60%), followed by vascular dementia (VD) (30-40%), and mixed dementia (10-20%), which in people older than 85 years of age may account for over 80% of the cases.…”

Section: Alzheimer's Diseasementioning

confidence: 99%

Epigenetics of Brain Disorders: The Paradigm of Alzheimer ’s Disease

Cacabelos¹

2016

J Alzheimers Dis Parkinsonism

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Over 80% of brain disorders are associated with multiple genomic defects in conjunction with environmental factors and epigenetic phenomena. Classical epigenetic mechanisms, including DNA methylation, histone modifications, and microRNAs (miRNAs) regulation, are among the major regulatory elements that control metabolic pathways at the molecular level, with epigenetic modifications controlling gene expression transcriptionally and miRNAs suppressing gene expression post-transcriptionally. Epigenetic modifications are related to disease development, environmental exposure, drug treatment and aging. Epigenetic changes are reversible and can be potentially targeted by pharmacological intervention. Both hypermethylation and hypomethylation of DNA, chomatin changes and miRNA dysregulation are common in age-related disorders and in many neuropsychiatric, neurodevelopmental and neurodegenerative disorders. Major epigenetic mechanisms may contribute to Alzheimer's disease (AD) pathology. Several pathogenic genes and many other AD-related susceptibility genes contain methylated CpG sites. AD brains exhibit a genome-wide decrease in DNA methylation. Pathogenic histone modifications are present in AD. Alterations in epigentically regulated miRNAs may contribute to the abnormal expression of pathogenic genes in AD. Epigenetic drugs can reverse epigenetic changes in gene expression and might open future avenues in AD therapeutics. Individual differences in drug response are associated with genetic and epigenetic variability and disease determinants. Pharmacoepigenomics deals with the influence that epigenetic alterations may exert on genes involved in the pharmacogenomic network (pathogenic, mechanistic, metabolic, transporter, and pleiotropic genes) responsible for the pharmacokinetics and pharmacodynamics of drugs (efficacy and safety), as well as the effects that drugs may have on the epigenetic machinery. family), AID/APOBEC family, and the VER glycosylase family [9]. Histone acetylation is achieved by histone acetyltransferase (HAT); and histone deacetylation is produced by histone deacetylases (HDACs) (class I: HDAC1, 2, 3, and 8; class IIa: HDAC4, 5,7, and 9; class IIb: HDAC6 and 10; class III: SIRT1, 2, 6, 7; class IV: HDAC11) [9].Long non-coding (lnc) RNAs are non-protein-coding RNAs, distinct from housekeeping RNAs (tRNAs, rRNAs, and snRNAs) and independent from small RNAs with specific molecular processing machinery. Over 95% of the eukaryotic genome is transcribed into non-coding RNAs and less than 5% is translated. LncRNA-mediated epigenetic regulation depends on lcnRNA interactions with proteins or genomic DNA via RNA secondary structures [10].Epigenomic modifications are involved in a great variety of physiological and pathological conditions; of major importance are those related with major problems of health such as cardiovascular disorders, obesity, cancer, inflammatory processes, and brain disorders [11,12]. A good paradigm on the influence of epigenetic factors on human pathology is the oncogenic ...

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The Clinical and Economic Burden of Newly Diagnosed Alzheimer’s Disease in a Medicare Advantage Population

Abstract: Members newly diagnosed with AD demonstrated greater HCRU, health care costs, and comorbidity burden compared to matched non-AD controls.

Cited by 64 publications

References 36 publications

Direct and indirect cost of managing alzheimer’s disease and related dementias in the United States

Direct and indirect cost of managing alzheimer’s disease and related dementias in the United States

The determinants of long-term care expenditure and their interactions

Epigenetics of Brain Disorders: The Paradigm of Alzheimer ’s Disease

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