Impact of diagnosis timing on AD cost and healthcare utilization

Abstract

AbstractBackgroundThis study aims to detect direct cost savings with early detection of Alzheimer’s disease (AD) and related dementias. We hypothesize that earlier diagnosis of AD can reduce direct healthcare costs and unnecessary utilization. A retrospective case‐control study is conducted using Optum Market Clarity Claims/EHR linked dataset on Medicare Advantage population from Jan 1 2011 to Dec 31 2020.MethodBased on whether the patient was diagnosed with prior Mild Cognitive Impairment (MCI) before progressing to an AD diagnosis per ICD‐9/10 cm diagnosis codes, AD patients are categorized into early vs. late diagnosis (for those who were identified in the MCI stage vs not). Both groups are compared on annual all‐cause healthcare costs and frequency of encounters longitudinally spanning across 6 years pre‐index period and 3 years post‐index with AD diagnosis date as the index date. To understand the impact of early diagnosis, we estimated total cost, medical service cost and drug cost post‐index within the first 3 years by risk adjustment on baseline demographics, comorbidities, procedures, lab tests, and visits prior to AD diagnosis using propensity score weighting.ResultEarly‐diagnosed patients (N = 421) have a lower utilization rate of inpatient skilled nursing facility, nursing home and hospitalization than late‐diagnosed patients (N = 2817) after being diagnosed with AD. We also observed average medical service cost savings in all 3 years post‐index, ranging from $320 to $2556 per patient per year. Per cost allocation analysis, medical service cost savings are observed in inpatient, emergency room, inpatient SNF, urgent care, nursing home/assisted living, and observation unit. Risk adjusted cost savings with statistical significance are observed in year 3 post‐index. The mean cost difference between late and early diagnoses: total cost ($15472.11), medical service ($15013.7) and medication cost ($1601.61).ConclusionThe study highlights opportunities for earlier diagnosis and suggests long‐term healthcare savings for AD patients who have been diagnosed at MCI stage compared to patients who were directly diagnosed with AD. Further research is needed to drill down into the driver of cost savings and whether it is attributable to disease management of MCI or other complications.