Abstract
Background: Antipsychotics are commonly used in dementia patients but have potential risks that often outweigh clinical benefits. Limited studies have assessed the healthcare utilization and medical costs associated with antipsychotic use, especially those focused on cumulative days of use. Objectives: To examine clinical and economic burdens associated with different cumulative days of antipsychotic use in older adults with dementia in the United States. Methods: This study used Medicare Current Beneficiary Survey (2015–2017). Older (≥65 years) Medicare beneficiaries with dementia, without concurrent schizophrenia, bipolar disorder, Huntingon’s disease, or Tourette’s syndrome were included. Antipsychotic use was measured using Medicare Part D prescription events. Healthcare utilization was measured as inpatient services, outpatient services, and emergency room (ER) visits. Total medical costs were classified as Medicare and out-of-pocket costs. The logistic regression, negative binomial regression, and generalized linear model with a log link and gamma distribution were used to examine factors, healthcare utilization, and medical costs. Survey sampling weights were applied to generate national estimates. Results: Among older adults with dementia, 13.18% used antipsychotics. Factors associated with antipsychotic use were being Hispanic (OR: 2.90; 95% CI: 1.45, 5.78), widowed (OR: 3.52; 95% CI: 1.46, 8.48), and single (OR: 3.25; 95% CI: 1.53, 6.87). Compared to non-users, antipsychotic use was associated with higher inpatient visits (IRR: 2.11; 95% CI 1.53, 2.90), ER visits (IRR: 1.61; 95% CI: 1.21, 2.13), total costs (β: 0.53; 95% CI: 0.36, 0.71), Medicare costs (β: 0.49; 95% CI 0.26, 0.72), and out-of-pocket costs (β: 0.66; 95% CI: 0.35, 0.97). With the increase in cumulative days of antipsychotic use, the magnitude of clinical and economic burdens was decreased. Conclusion: The significant clinical and economic burdens associated with antipsychotic use, especially with short-term use, provide real-world evidence to inform clinical practice on deprescribing antipsychotics among community-dwelling geriatric dementia patients.
Highlights
Dementia is a syndrome characterized by progressive cognitive function deterioration with various etiology (van der Flier and Scheltens, 2005)
Ethnicity and marital status were two characteristics associated with antipsychotic use in older adults with dementia identified in this study
This study found that the use of antipsychotics among older adults with dementia was associated with a higher economic burden
Summary
Dementia is a syndrome characterized by progressive cognitive function deterioration with various etiology (van der Flier and Scheltens, 2005). BPSD encompasses a range of symptoms caused by disturbances in the individual’s mood, behavior, thoughts, and perception; symptoms of BPSD include agitation, psychosis, and aggression (Kales et al, 2015) It is highly prevalent and is estimated to affect up to 80% of individuals with dementia (Kirkham et al, 2017). Environmental strategies, and patient-oriented approaches are all potential nonpharmacological approaches that can be attempted initially to manage BPSD (Kales et al, 2015) These strategies might not always be effective and appropriate when BPSD symptoms are severe, dangerous, and cause significant patient distress (Reus et al, 2016). Limited studies have assessed the healthcare utilization and medical costs associated with antipsychotic use, especially those focused on cumulative days of use
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