MAINTAINING COGNITIVE IMPAIRMENT PATIENTS IN A MILDER DISEASE STAGE RESULTS IN LESS HEALTHCARE RESOURCE UTILIZATION

Abstract

Patients suffering from advanced stages of Alzheimer’s disease (AD) could incur high costs because of gradual loss of the basic life functions and the supervision required. This analysis aimed to compare the healthcare resource utilization (HCRU) of patients in different stages of cognitive impairment (CI). Data were taken from the 2013 Adelphi Real World Dementia Disease Specific Programme, a cross-sectional survey of physicians, and patients over 50 years old with CI in France, Germany, Italy, Spain, the UK and the US. Physicians completed patient record forms containing patient demographics, clinical characteristics and HCRU. Patients were classified into four CI subgroups based on their current mini–mental state examination score and diagnostic labels; prodromal (24-30), mild (18-23), moderate (10-17) and severe (<10). The latter three groups had a diagnostic label of AD, early onset AD or mixed dementia, while the first group could not have one of these labels but had a mild CI (MCI), amnestic MCI, pre-dementia AD or prodromal AD label. Propensity score matching, controlling for patient demographics and clinical characteristics, was used to assess differences in HCRU between prodromal/mild patients and moderate/severe patients. Statistical significance was assessed via the calculation of the Abadie-Imbens standard error. A total of 3592 patients (median age 78.0, 55.5% female) were collected, of which 1959 were prodromal/mild patients and 1633 moderate/severe. Each moderate/severe patient was matched 1:1 to a prodromal/mild patient with replacement. After matching, all covariates had an absolute standardised mean difference <10%. The mean differences in specialist consultations (4.5 moderate/severe versus 3.8 prodromal/mild), number of hospitalizations (0.4 vs 0.3) and number of inpatient days (3.7 vs 1.5) in the last 12 months were all statistically significant (p<0.05). Moderate/severe patients also required significantly more professional caregiver hours per week (36.7 vs 20.8, p<0.001) and a significantly higher proportion of these patients were institutionalized (21.4 vs 8.8, p<0.001). Later stage CI patients incur more HCRU than prodromal/mild patients, consequently imposing a heavier burden on healthcare system. Therefore, therapies that could delay cognitive decline can have the potential for important clinical benefits and substantial cost savings for healthcare systems in countries with rapidly aging populations.