In this study, the authors estimated the direct health care costs attributable to ADRD among older adults within a large MA plan. A retrospective cohort design was used to estimate direct total, outpatient, inpatient, ambulatory pharmacy, and nursing home costs for 3 years before and after an incident ADRD diagnosis for 927 individuals diagnosed with ADRD relative to a sex-matched and birth year-matched set of 2945 controls. The authors found that greater total health care costs among individuals with ADRD are primarily driven by nursing home costs.
Fishman P; White L; Ingraham B; Larson EB; Crane PK; Coe NB: Health Care Costs of Alzheimer’s and Related Dementias within a Medicare Managed Care Provider. Medical Care. Sep 2020. 58(9) 833-841
Sociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. The study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Methods: Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, the authors identified a retrospective cohort of adults with at least one International Classification of Diseases—ninth revision—Clinical Modification (ICD-9-CM) dementia diagnosis code (n = 3,714). For each case, the authors randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year (n = 9,531), and assigned comparators the diagnosis date of their matched case. The authors estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.
White L, Fishman P, Basu A, Crane PK, Larson EB, Coe NB. Dementia Is Associated With Earlier Mortality for Men and Women in the United States. Gerontology and Geriatric Medicine, 2020 Aug.
Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias
The purpose of this study was to determine differences in health care utilization, care satisfaction, and health status for Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries with and without Alzheimer’s Disease and Related Dementias (ADRD). A cohort study was conducted of MA and TM beneficiaries with and without ADRD from all publicly available years of the Medicare Current Beneficiary Survey between 2010 and 2016. To address advantageous selection into MA plans, county-level MA enrollment rate was used as an instrument. Data were analyzed between July 2019 and December 2019. Compared with TM beneficiaries, MA beneficiaries had lower health care utilization without compromising care satisfaction and health status. This difference was more pronounced among beneficiaries with ADRD. These findings suggest that MA plans may be delivering health care more efficiently than TM, especially for beneficiaries with ADRD.
Park S, White L, Fishman P, Larson EB, Coe NB: Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias. JAMA Network Open 3(3), Mar 2020.
In this article, the authors conducted a systematic review of studies reporting the direct healthcare costs of treating older adults with diagnosed Alzheimer disease and related dementias (ADRD) within private Medicare managed care plans.
P Fishman, NB Coe, L White, S Park, B Ingraham, EB Larson. “Cost of Dementia in Managed Care: A Systematic Literature Review” American Journal of Managed Care. 2019. August.
This article estimates dementia's incremental cost to the traditional Medicare program. The authors compared Medicare expenditures for 60 months following a claims-based dementia diagnosis to those for a randomly selected, matched comparison group. Dementia's five-year incremental cost to the traditional Medicare program is approximately $15 700 per patient, nearly half of which is incurred in the first year after diagnosis. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services.
White, L, P Fishman, A Basu, EB Larson, NB Coe, “Medicare Expenditures Attributable to Dementia.” Health Services Research. 2019. P 1-9
Coe, NB, HM von Gaudecker, M Lindeboom, and J Maurer. “The Effect of Retirement on Cognitive Functioning.” Health Economics 2012; 21(8):913-927.