Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
It’s here! I wait every year for the Alzheimer’s Disease Facts and Figures. This year the 122-page report also includes a special report: More Than Normal Aging: Understanding Mild Cognitive Impairment (MCI).
2022 Alzheimer’s Disease Facts and Figures is a statistical resource for U.S. data related to Alzheimer’s disease, the most common cause of dementia. Background and context for interpretation of the data are contained in the Overview. Additional sections address prevalence, mortality and morbidity, caregiving, the dementia care workforce, and the use and costs of health care, long-term care, and hospice. A Special Report examines consumers’ and primary care physicians’ perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer’s disease.
Here’s a look at the contents:
“Projections for the Future: Total annual payments for health care, long-term care and hospice care for people with Alzheimer’s or other dementias are projected to increase from $321 billion in 2022 to just under $1 trillion in 2050 (in 2022 dollars). This dramatic rise includes three-fold increases both in government spending under Medicare and Medicaid and in out-of-pocket spending. Concurrent with this large projected increase, the Medicare Hospital Insurance Trust Fund, which covers spending for Medicare Part A (hospital care), is projected to go into a deficit, suggesting that broad changes to Medicare may be needed.
Potential Impact of Changing the Trajectory of Alzheimer’s Disease: While there are currently no FDA-approved treatments that prevent or cure Alzheimer’s disease, a recently FDA accelerated approved anti-amyloid therapy reduces one of the defining brain changes of the disease — amyloid plaques. This reduction in amyloid plaques is reasonably likely to result in clinical benefit. This anti-amyloid treatment was tested in people living with MCI due to Alzheimer’s disease and mild Alzheimer’s dementia with confirmed amyloid in the brain. There are several other anti-amyloid drugs in late-stage development.
Several groups of researchers have estimated the health and long-term care cost implications of hypothetical future interventions that either slow the onset of dementia or reduce the symptoms. One analysis assumed a treatment that delayed onset of Alzheimer’s by five years would be introduced in 2025. It estimated that such a treatment would reduce total health and long-term care spending for people with Alzheimer’s by 33%, including a 44% reduction in out-of-pocket payments, in 2050. A second study estimated how much would be saved with treatments that delayed the onset of Alzheimer’s disease by one to five years. For individuals age 70 and older, the study projected that in 2050, there would be a 14% reduction in total health care spending for people with Alzheimer’s from a one-year delay, a 27% reduction from a three-year delay and a 39% reduction from a five-year delay. Beyond the single-year costs, the study also found that a delay in onset may increase total lifetime per capita health care spending due to longer life associated with delaying the onset of dementia, although the additional health care costs may be offset by lower informal care costs. Finally, a third study estimated that a treatment slowing the rate of functional decline among people with dementia by 10% would reduce total average per-person lifetime costs by $3,880 in 2015 dollars ($4,553 in 2021 dollars), while a treatment that reduces the number of behavioral and psychological symptoms by 10% would reduce total average per-person lifetime costs by $680 ($798 in 2021 dollars).
A therapy that changes the course of the disease may not be the only way to reduce health and long-term care costs. The Alzheimer’s Association commissioned a study of the potential cost savings of early diagnosis, assuming that 88% of individuals who will develop Alzheimer’s disease would be diagnosed in the MCI phase rather than the dementia phase or not at all. Approximately $7 trillion could be saved in medical and long-term care costs for individuals who were alive in 2018 and will develop Alzheimer’s disease. Cost savings were the result of (1) a smaller spike in costs immediately before and after diagnosis during the MCI phase compared with the higher-cost dementia phase, and (2) lower medical and long-term care costs for individuals who have diagnosed and managed MCI and dementia compared with individuals with unmanaged MCI and dementia.
The potential savings from a treatment or an earlier diagnosis may depend on structural changes to the health care system. Capacity constraints — such as a limited number of qualified providers and facilities — could severely restrict access to new treatments. For example, modeling by the RAND Corporation in 2017 showed that with an anti-amyloid therapy for people in the MCI and early dementia stages of the disease, approximately 2.1 million individuals with MCI due to Alzheimer’s disease would develop Alzheimer’s dementia between 2020 and 2040 while on waiting lists for treatment. This model assumed that the hypothetical treatment would require infusions at infusion centers and PET scans to confirm the presence of amyloid in the brain to support initiation of treatment with an anti-amyloid medication.”
Please review and share this important report with your team and colleagues.