Differences in Medicare Utilization and Expenditures in the Last Six Months of Life among Patients with and without Alzheimer's Disease and Related Disorders.

Abstract

Previous research has not focused on differences at the end of life among Medicare beneficiaries with, and without, a diagnosis of Alzheimer's disease and related disorders (ADRDs). The purpose of this study was to examine differences in utilization of inpatient services and Medicare expenditures (overall and by category) in the last six months of life for patients with, versus those without, a diagnosis of ADRD. The study used 2013 Medicare Research Identifiable Files (5% sample) to study utilization and expenditures for a full six months before death (n = 7895 for ADRD; n = 30,639 for non-ADRD). A generalized linear model with a gamma distribution was used to examine the association of ADRD with end-of-life service utilization and expenditures. ADRD patients were overall less expensive than their non-ADRD peers through reduced use of high-cost services, and urban patients were more likely than rural patients to use hospice and other services among both the ADRD and non-ADRD groups. After controlling for age, gender, race, dual eligibility, residence, region, chronic conditions, and type of service utilization, ADRD beneficiaries cost Medicare 11% less than non-ADRD beneficiaries (p < 0.01). Future research should examine the informal caregiving costs of caring, which is a significant part of care for an ADRD patient, as the residential setting of the beneficiary highly influences costs.