Assessing the economic burden of Alzheimer’s disease patients first diagnosed by specialists
Open accessAbstract
BACKGROUND: It is not known if there is a differential impact on Alzheimer's disease (AD) diagnosis and outcomes if/when patients are diagnosed with cognitive decline by specialists versus non-specialists. This study examined the cost trajectories of Medicare beneficiaries initially diagnosed by specialists compared to similar patients who received their diagnosis in primary care settings. METHODS: Patients with ≥2 claims for AD were selected from de-identified administrative claims data for US Medicare beneficiaries (5 % random sample). The earliest observed diagnosis of cognitive decline served as the index date. Patients were required to have continuous Medicare coverage for ≥12 months pre-index (baseline) and ≥12 months following the first AD diagnosis, allowing for up to 3 years from index to AD diagnosis. Time from index date to AD diagnosis was compared between those diagnosed by specialists (i.e., neurologist, psychiatrist, or geriatrician) versus non-specialists using Kaplan-Meier analyses with log-rank tests. Patient demographics, Charlson Comorbidity Index (CCI) during baseline, and annual all-cause medical costs (reimbursed by Medicare) in baseline and follow-up periods were compared across propensity-score matched cohorts. RESULTS: Patients first diagnosed with cognitive decline by specialists (n = 2593) were younger (78.8 versus 80.8 years old), more likely to be male (40 % versus 34 %), and had higher CCI scores and higher medical costs at baseline than those diagnosed by non-specialists (n = 13,961). However, patients diagnosed by specialists had a significantly shorter time to AD diagnosis, both before and after matching (mean [after matching]: 3.5 versus 4.6 months, p < 0.0001). In addition, patients diagnosed by specialists had significantly lower average total all-cause medical costs in the first 12 months after their index date, a finding that persisted after matching ($19,824 versus $25,863, p < 0.0001). Total per-patient annual medical costs were similar for the two groups starting in the second year post-index. CONCLUSIONS: Before and after matching, patients diagnosed by a specialist had a shorter time to AD diagnosis and incurred lower costs in the year following the initial cognitive decline diagnosis. Differences in costs converged during subsequent years. This suggests that seeking care from specialists may yield more timely diagnosis, appropriate care and reduced costs among those with cognitive decline.
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Individuals diagnosed with cognitive impairment by a specialist had lower Medicare costs in the year after receiving a diagnosis of Alzheimer's dementia than those diagnosed by a non-specialist.
“Additionally, individuals diagnosed with cognitive impairment by a specialist had lower Medicare costs in the year after receiving a diagnosis of Alzheimer's dementia than those diagnosed by a non‐specialist.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [883]
The Abstract Results report lower Medicare-reimbursed medical costs for patients first diagnosed with cognitive decline by specialists than for those diagnosed by non-specialists. But the measured year began at the initial cognitive-decline diagnosis (the index date), not at the later Alzheimer’s diagnosis; the Methods distinguish those dates. No page numbers are available in our copy. (LLM, conf=0.89)
Experimental — accuracy not yet measuredOne group of researchers found that individuals with cognitive decline who sought care from a specialist (neurologist, psychiatrist, or geriatrician) had a shorter time to diagnosis of Alzheimer's disease.
“One group of researchers found that individuals with cognitive decline who sought care from a specialist (that is, a neurologist, psychiatrist or geriatrician) had a shorter time to diagnosis of Alzheimer's disease. 883”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [883]
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- Authors
- Kirson, N. Y., Desai, U., Ristovska, L., Cummings, A. K. G., Birnbaum, H. G., Ye, W., Andrews, J. S., Ball, D., & Kahle-Wrobleski, K.
- Affiliations
- Analysis Group (United States) (US)
- Eli Lilly (United States) (US)
- Corresponding author
- Desai, Urvi
- Venue
- BMC Geriatrics
- Published
- 2016-07-11
- Volume
- 16
- Issue
- 1
- Pages
- 138-138
- ISSN
- 1471-2318 (ISSN-L)
- PMC
- PMC4940962
- OpenAlex
- W2472843264
- Cited by
- 42
- References
- 11
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 9 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 3 · 2017: 2
- FWCI
- 2.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Geriatrics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company (US)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Keywords
- Alzheimer's disease, economic burden, cognitive decline, primary care diagnosis, time to diagnosis, health care costs, Medicare beneficiaries, comorbidities, cost trajectories
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Costs and Cost Analysis, Female, Medicare, Humans, Male, Primary Health Care, Psychiatry, Psychological Techniques, Referral and Consultation, Retrospective Studies, United States, Cost of Illness, Early Diagnosis
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