How much does it really cost to care for persons with Alzheimer's disease?

Cost of dementia in Medicare managed care: a systematic literature review

OBJECTIVES

We conducted a systematic review of studies reporting the direct healthcare costs of treating older adults with diagnosed Alzheimer disease and related dementias (ADRD) within private Medicare managed care plans.

STUDY DESIGN

A systematic review of all studies published in English reporting original empirical analyses of direct costs for older adults with ADRD in Medicare managed care.

METHODS

All papers indexed in PubMed or Web of Science reporting ADRD costs within Medicare managed care plans from 1983 through 2018 were identified and reviewed.

RESULTS

Despite the growth in Medicare managed care enrollment, only 9 papers report the costs of care for individuals with ADRD within these plans, and only 1 study reports data less than 10 years old. This limited literature reports wide ranges for ADRD-attributable costs, with estimates varying from $3738 to $8726 in annual prevalent costs and $8938 to $38,794 in 1-year immediate postdiagnosis incident costs. Reviewed studies also used varied study populations, case and cost ascertainment methods, and analytic methods, making cross-study comparisons difficult.

CONCLUSIONS

The expected continued growth in Medicare managed care enrollment, coupled with the large and growing impact of ADRD on America's healthcare delivery and finance systems, requires more research on the cost of ADRD within managed care. This research should use more consistent approaches to identify ADRD prevalence and provide more detail regarding which components of care are included in analyses and how the costs of care are captured and measured.

Impact of patient selection criteria on prevalence estimates and prevalence of diagnosed dementia in a Medicaid population

OBJECTIVES

This study estimated the prevalence of diagnosed dementia among Indiana Medicaid beneficiaries in 2004. The dependence of prevalence estimates upon use of several patient selection criteria to identify patients with dementia also was evaluated.

METHODS

Indiana Medicaid claims data were analyzed for the period July 1, 2002 to December 31, 2004. An expert panel survey was conducted to assess perceived specificity of ICD codes used in previous studies to define dementia. Prevalence estimates were calculated with varying levels of each selection criteria, that is, ICD code set, interval of data examined, and number of occurrences of dementia-related claims. To assess specificity and sensitivity of the dementia patient selection criteria, Minimum Data Set data for a subset of beneficiaries that resided in a nursing home any time in 2004 were examined.

RESULTS

Depending on the patient selection criteria used, estimates of prevalence of diagnosed dementia for individuals 40 years old or older varied from 7.7% to 15.3%, whereas prevalence estimates for individuals 60 years old or older varied from 14.5% to 26.6%. When the following selection criteria were used: (1) occurrence of one or more dementia-related claims, (2) the expert panel ICD set, and (3) up to 30 months of data for defining dementia, the prevalence estimates in the Indiana Medicaid population were 10.9% for individuals 40 years old or older and 20.3% for individuals 60 years old or older.

CONCLUSIONS

Careful selection of claims-based criteria for identifying patients with dementia is important because the criteria may affect estimates by 100%. Prevalence of diagnosed dementia among Indiana Medicaid beneficiaries was 3 to 4 times higher than the reported prevalence from a decade ago in Medicaid populations of other states, even when the same patient selection criteria were used. A number of factors beyond increased occurrence of the disease including increased screening, greater likelihood of recording dementia codes in claims, or other factors may be responsible. The combination of patient selection criteria used in this study had good sensitivity, specificity, and accuracy when compared with Minimum Data Set data.