P2‐304: AN ECONOMIC EVALUATION OF A NOVEL COMPUTERIZED COGNITIVE TEST IN DEMENTIA

Abstract

The global burden of dementia is about $1 trillion, annually, and one of the most challenging aspects of dementia is accurate and timely diagnosis and monitoring. In this paper, we develop a conceptual model to identify the economic aspects of a novel dementia diagnostic (referred to as “DDx”). We describe the logic and evidence surrounding the “cost offset” aspects associated with the use of DDx due, in part, to its increased speed and accuracy of diagnosis which ultimately leads to earlier disease-modifying treatments. The conceptual model focuses on four potential cost-driver domains: (1) diagnosis, (2) treatment, (3) outcomes, and (4) institutional care. We adopt a U.S. payer perspective and depict a hypothetical medical decision whereby patients from the base cohort can be “primarily diagnosed” via either the standard of care arm or the DDx arm. The main hypotheses are that the two arms may not be mutually exclusive in terms of testing, yet DDx is reflective of a more accurate and efficient approach. We then develop a cost analysis based on the main cost drivers and the flow of our model, alongside our own reasonable assumptions and cost evidence found in the literature. Faster time-to-treatment results in three desirable outcomes: (1) creating more opportunity to deliver optimal treatment, including the optimal mix of pharmacological and non-pharmacological treatments; (2) a delay in institutional care facility (ICF) admission; and (3) faster time-to-treatment has also been shown to reduce avoidable hospitalizations, which is also an important component of the overall costs of dementia. Summing these effects, the net potential savings attributable to DDx is $11,156, which represents a 13.8% savings per episode of dementia, compared to the standard of care. Savings are driven by reduction in diagnostic costs, hospitalization costs, and ICF costs. The savings attributable to DDx will accrue to different stakeholders in the U.S. in different ways. Fully-integrated health systems would accrue savings directly to the payers, while commercial insurance markets would experience shared savings between commercial health insurers and long-term care.