DIAGNOSTIC AND TREATMENT PATTERNS AND HEALTHCARE RESOURCE UTILIZATION AMONG DIAGNOSED DEMENTIA PATIENTS IN THE UNITED STATES

Abstract

Background: Populations affected with a dementia will grow each year as the number and proportion of elder population (age 65) continue to increase. While it is known that a dementia diagnoses is associated with high direct and indirect costs, no data are available describing healthcare resource utilization (HRU) associated with diagnostic and treatment patterns in these patients. Methods: Using medical and pharmacy claims data between October 1, 2007 and September 30, 2012, subjects were selected from one of the diagnostic algorithms (1. Dementia not otherwise specified 2.Dementia diagnosis by specialist, 3. Dementia diagnosis by generalist). Subjects were required to have 1 year continuous enrollment pre-index date (date of first dementia diagnosis) and post-confirmed date (time of the confirmed diagnosis to end of available data) without prior dementia diagnosis or dementia-related medications. Time from first to confirmed dementia diagnosis was defined as diagnostic work-up period. All data were analyzed separately for the private-insured population (private) and the Medicare supplemental insurance population (Medicare). Results: Of the 745 private patients (61.1% female; mean age 1⁄459.8), 39.6% had a first dementia diagnosis of mild cognitive impairment(MCI), 21.6% Alzheimer’s disease(AD), 6.0% vascular dementia(VD), 1.9% frontotemporal, and 1.1% lewy body dementia(LBD). The average diagnostic work up period was 93.4 days. There were more average number of HRU per 100 member per month (PMPM) during diagnostic period compared to post-diagnosis period (head CT scan: 4.7 vs. 1.2; head/brain MRI: 20.7 vs. 2.0; generalist visit: 55.3 vs. 51.6; specialist visit: 90.7 vs. 33.7; emergency room visit: 4.4 vs. 3.6; inpatient admission: 5.0 vs.2.0). Of the 7,911 Medicare patients (62.0% female; mean age 1⁄481.6), 15.7% had a first dementia diagnosis of MCI, 59.0% AD, 8.0% VD, 0.5% frontotemporal, and 2.1% LBD. The average diagnostic work up period was 127.5 days. PMPMHRUwas higher during diagnostic period compared with postdiagnosis period (head CT scan: 12.2 vs. 3.7; head/brain MRI: 3.2 vs. 0.9; generalist visit: 100.3 vs. 79.5; specialist visit: 43.9 vs. 26.1; emergency room visit: 4.7 vs. 4.4; inpatient admission: 11.0 vs. 3.0). Conclusions: Data support that earlier diagnosis is associated with fewer use of health care utilization.