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Assessing the economic burden of Alzheimer's disease patients first diagnosed by specialists.

Kirson NY, Desai U, Ristovska L, Cummings AK, Birnbaum HG, Ye W, Andrews JS, Ball D, Kahle-Wrobleski K - BMC Geriatr (2016)

Bottom Line: Time from index date to AD diagnosis was compared between those diagnosed by specialists (i.e., neurologist, psychiatrist, or geriatrician) versus non-specialists using Kaplan-Meier analyses with log-rank tests.Patient demographics, Charlson Comorbidity Index (CCI) during baseline, and annual all-cause medical costs (reimbursed by Medicare) in baseline and follow-up periods were compared across propensity-score matched cohorts.In addition, patients diagnosed by specialists had significantly lower average total all-cause medical costs in the first 12 months after their index date, a finding that persisted after matching ($19,824 versus $25,863, p < 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Analysis Group, Inc., 111 Huntington Ave, 14th floor, Boston, MA, 02199, USA.

ABSTRACT

Background: It is not known if there is a differential impact on Alzheimer's disease (AD) diagnosis and outcomes if/when patients are diagnosed with cognitive decline by specialists versus non-specialists. This study examined the cost trajectories of Medicare beneficiaries initially diagnosed by specialists compared to similar patients who received their diagnosis in primary care settings.

Methods: Patients with ≥2 claims for AD were selected from de-identified administrative claims data for US Medicare beneficiaries (5 % random sample). The earliest observed diagnosis of cognitive decline served as the index date. Patients were required to have continuous Medicare coverage for ≥12 months pre-index (baseline) and ≥12 months following the first AD diagnosis, allowing for up to 3 years from index to AD diagnosis. Time from index date to AD diagnosis was compared between those diagnosed by specialists (i.e., neurologist, psychiatrist, or geriatrician) versus non-specialists using Kaplan-Meier analyses with log-rank tests. Patient demographics, Charlson Comorbidity Index (CCI) during baseline, and annual all-cause medical costs (reimbursed by Medicare) in baseline and follow-up periods were compared across propensity-score matched cohorts.

Results: Patients first diagnosed with cognitive decline by specialists (n = 2593) were younger (78.8 versus 80.8 years old), more likely to be male (40 % versus 34 %), and had higher CCI scores and higher medical costs at baseline than those diagnosed by non-specialists (n = 13,961). However, patients diagnosed by specialists had a significantly shorter time to AD diagnosis, both before and after matching (mean [after matching]: 3.5 versus 4.6 months, p < 0.0001). In addition, patients diagnosed by specialists had significantly lower average total all-cause medical costs in the first 12 months after their index date, a finding that persisted after matching ($19,824 versus $25,863, p < 0.0001). Total per-patient annual medical costs were similar for the two groups starting in the second year post-index.

Conclusions: Before and after matching, patients diagnosed by a specialist had a shorter time to AD diagnosis and incurred lower costs in the year following the initial cognitive decline diagnosis. Differences in costs converged during subsequent years. This suggests that seeking care from specialists may yield more timely diagnosis, appropriate care and reduced costs among those with cognitive decline.

No MeSH data available.


Related in: MedlinePlus

Study time periods
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Fig1: Study time periods

Mentions: Medicare beneficiaries with at least two distinct claims with a diagnosis code for Alzheimer’s disease (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 331.0), with the first such claim occurring in the period 2009 through 2012, were identified as AD patients. The AD patients identified in this same period (2009 through 2012) whose first claim for cognitive impairment (“index date”; ICD-9-CM: 290.x, 291.1, 291.2, 292.82–83, 294.x, 331.x, 780.93) was before or at the date of AD diagnosis were also included in the analysis. Continuous Medicare enrollment was required during the 12 months prior to the index date (baseline period), the period between the index date and the first AD diagnosis, and the 12 months following and including the first AD diagnosis, resulting in a follow-up period of at least 12 months and up to 36 months after the index date (Fig. 1). Patients were then stratified into two cohorts depending on whether they were first diagnosed as having cognitive impairment (i.e., on their index date) by a specialist or not. A diagnosis was considered to be made by a specialist if the corresponding claim listed the physician specialty as a neurologist, psychiatrist, or geriatrician.Fig. 1


Assessing the economic burden of Alzheimer's disease patients first diagnosed by specialists.

Kirson NY, Desai U, Ristovska L, Cummings AK, Birnbaum HG, Ye W, Andrews JS, Ball D, Kahle-Wrobleski K - BMC Geriatr (2016)

Study time periods
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940962&req=5

Fig1: Study time periods
Mentions: Medicare beneficiaries with at least two distinct claims with a diagnosis code for Alzheimer’s disease (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 331.0), with the first such claim occurring in the period 2009 through 2012, were identified as AD patients. The AD patients identified in this same period (2009 through 2012) whose first claim for cognitive impairment (“index date”; ICD-9-CM: 290.x, 291.1, 291.2, 292.82–83, 294.x, 331.x, 780.93) was before or at the date of AD diagnosis were also included in the analysis. Continuous Medicare enrollment was required during the 12 months prior to the index date (baseline period), the period between the index date and the first AD diagnosis, and the 12 months following and including the first AD diagnosis, resulting in a follow-up period of at least 12 months and up to 36 months after the index date (Fig. 1). Patients were then stratified into two cohorts depending on whether they were first diagnosed as having cognitive impairment (i.e., on their index date) by a specialist or not. A diagnosis was considered to be made by a specialist if the corresponding claim listed the physician specialty as a neurologist, psychiatrist, or geriatrician.Fig. 1

Bottom Line: Time from index date to AD diagnosis was compared between those diagnosed by specialists (i.e., neurologist, psychiatrist, or geriatrician) versus non-specialists using Kaplan-Meier analyses with log-rank tests.Patient demographics, Charlson Comorbidity Index (CCI) during baseline, and annual all-cause medical costs (reimbursed by Medicare) in baseline and follow-up periods were compared across propensity-score matched cohorts.In addition, patients diagnosed by specialists had significantly lower average total all-cause medical costs in the first 12 months after their index date, a finding that persisted after matching ($19,824 versus $25,863, p < 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Analysis Group, Inc., 111 Huntington Ave, 14th floor, Boston, MA, 02199, USA.

ABSTRACT

Background: It is not known if there is a differential impact on Alzheimer's disease (AD) diagnosis and outcomes if/when patients are diagnosed with cognitive decline by specialists versus non-specialists. This study examined the cost trajectories of Medicare beneficiaries initially diagnosed by specialists compared to similar patients who received their diagnosis in primary care settings.

Methods: Patients with ≥2 claims for AD were selected from de-identified administrative claims data for US Medicare beneficiaries (5 % random sample). The earliest observed diagnosis of cognitive decline served as the index date. Patients were required to have continuous Medicare coverage for ≥12 months pre-index (baseline) and ≥12 months following the first AD diagnosis, allowing for up to 3 years from index to AD diagnosis. Time from index date to AD diagnosis was compared between those diagnosed by specialists (i.e., neurologist, psychiatrist, or geriatrician) versus non-specialists using Kaplan-Meier analyses with log-rank tests. Patient demographics, Charlson Comorbidity Index (CCI) during baseline, and annual all-cause medical costs (reimbursed by Medicare) in baseline and follow-up periods were compared across propensity-score matched cohorts.

Results: Patients first diagnosed with cognitive decline by specialists (n = 2593) were younger (78.8 versus 80.8 years old), more likely to be male (40 % versus 34 %), and had higher CCI scores and higher medical costs at baseline than those diagnosed by non-specialists (n = 13,961). However, patients diagnosed by specialists had a significantly shorter time to AD diagnosis, both before and after matching (mean [after matching]: 3.5 versus 4.6 months, p < 0.0001). In addition, patients diagnosed by specialists had significantly lower average total all-cause medical costs in the first 12 months after their index date, a finding that persisted after matching ($19,824 versus $25,863, p < 0.0001). Total per-patient annual medical costs were similar for the two groups starting in the second year post-index.

Conclusions: Before and after matching, patients diagnosed by a specialist had a shorter time to AD diagnosis and incurred lower costs in the year following the initial cognitive decline diagnosis. Differences in costs converged during subsequent years. This suggests that seeking care from specialists may yield more timely diagnosis, appropriate care and reduced costs among those with cognitive decline.

No MeSH data available.


Related in: MedlinePlus