Real-world healthcare resource utilization of Alzheimer’s disease in the early and advanced stages: a retrospective cohort study
Creators: name: Fazio-Eynullayeva, Elnara
name: Cunnington, Marianne
name: Mystkowski, Paul
name: Lv, Lei
name: Aly, Abdalla
name: Yee, Christopher W.
name: Desai, Raj
name: Liu, Chia-Lun
name: Duh, Mei Sheng
name: Mattke, Soeren
Publisher: name: Taylor & Francis
Year: 2024
Subjects: Medicine
Neuroscience
Mental Health
Hematology

description: To compare all-cause and Alzheimer’s disease (AD)-related healthcare resource utilization (HCRU) by cognitive stage. This retrospective study analyzed insurance claims data linked to electronic health records (01/01/2015-12/31/2021). Patients with ≥1 cognitive assessment (Mini-Mental State Examination or Montreal Cognitive Assessment) and ≥1 medical or pharmacy claim for an AD diagnosis or AD medications were included. Inverse probability of treatment weighting (IPTW) was used to address potential confounding. All-cause and AD-related HCRU were summarized per patient per year (PPPY) and compared between early AD and advanced AD cohorts (defined according to cognitive scores) using generalized linear regression models; adjusted incidence rate ratios (IRRs), and 95% confidence intervals (CI) were reported. A total of 193 patients were included (median age: 82 years; 63.2% female), 108 with early AD and 85 with advanced AD, with similar mean follow up. All-cause HCRU, on average, was similar between early AD and advanced AD cohorts (37.4 PPPY and 38.9 encounters PPPY, respectively). For AD-related HCRU, patients with early AD had fewer encounters PPPY, on average, than patients with advanced AD (1.26 and 3.88 encounters, respectively). Following IPTW adjustment, the advanced AD cohort had significantly higher overall AD-related HCRU (IRR: 3.64 [95% CI: 1.96-6.75], <i>p</i> &lt; 0.001) and outpatient visits (IRR: 2.76 [95% CI: 1.68-4.54], <i>p</i> &lt; 0.001) compared to the early AD cohort. The relatively small sample size of patients with linked claims and cognitive score data limited the ability to assess contribution of all encounter types to HCRU trends, as well as generalizability to the broader AD population. Although all-cause HCRU was similar, patients with advanced AD incurred higher AD-related HCRU compared to patients living with early AD. Further research is needed to determine whether interventions earlier in disease progression can mitigate the AD-related healthcare burden for patients with advanced AD. Alzheimer’s disease (AD) is the main cause of dementia in older adults in the United States. Beyond the clinical challenges faced by patients with AD, the burden of healthcare resource utilization (HCRU) from different types of healthcare visits and interactions are significant. However, differences in HCRU burden between patients with early and advanced AD is not well studied. We conducted a study using insurance claims data linked to electronic health records to compare all-cause and AD-related HCRU between patients with early and advanced AD. A total of 108 patients with early AD and 85 patients with advanced AD were included. There was no statistically significant difference in all-cause HCRU between the groups which may reflect changing patterns of healthcare interactions as AD progresses. However, patients with advanced AD incurred significantly higher HCRU related to their underlying AD, on average 3.64 times more frequent healthcare encounters of any type compared to patients living with early AD. This was driven by higher rates of AD-related outpatient visits among the advanced AD cohort. The significantly higher AD-related HCRU in patients with advanced AD, compared to those in the early stages, highlights the potential for disease-modifying treatments administered earlier in the disease course to significantly reduce the associated healthcare burden.