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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

Components of costs in Year 1 of follow-up period. NOTE: patients diagnosed by specialists versus no specialists (after matching). Abbreviations DME = durable medical equipment; SNF = skilled nursing facilities; USD = United States dollars. Note: Differences across cohorts are statistically significant at p<0.05 for all places of service. Inpatient stays include stays originating from the emergency department
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Fig5: Components of costs in Year 1 of follow-up period. NOTE: patients diagnosed by specialists versus no specialists (after matching). Abbreviations DME = durable medical equipment; SNF = skilled nursing facilities; USD = United States dollars. Note: Differences across cohorts are statistically significant at p<0.05 for all places of service. Inpatient stays include stays originating from the emergency department

Mentions: In terms of costs by place of service during the first year of the follow-up period, AD patients first diagnosed with cognitive impairment by a specialist had significantly lower costs, on average, in every place of service compared to the matched control population, with the exception of physician office visits (Fig. 5). The difference in inpatient costs (−$2940, p < 0.0001) comprised 48.7 % of the difference in total medical costs among the two cohorts, followed by the difference in skilled nursing facility costs, which accounted for 32.9 % (−$1986, p < 0.0001) of the overall all-cause medical cost differential.Fig. 5


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)

Components of costs in Year 1 of follow-up period. NOTE: patients diagnosed by specialists versus no specialists (after matching). Abbreviations DME = durable medical equipment; SNF = skilled nursing facilities; USD = United States dollars. Note: Differences across cohorts are statistically significant at p<0.05 for all places of service. Inpatient stays include stays originating from the emergency department
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Components of costs in Year 1 of follow-up period. NOTE: patients diagnosed by specialists versus no specialists (after matching). Abbreviations DME = durable medical equipment; SNF = skilled nursing facilities; USD = United States dollars. Note: Differences across cohorts are statistically significant at p<0.05 for all places of service. Inpatient stays include stays originating from the emergency department
Mentions: In terms of costs by place of service during the first year of the follow-up period, AD patients first diagnosed with cognitive impairment by a specialist had significantly lower costs, on average, in every place of service compared to the matched control population, with the exception of physician office visits (Fig. 5). The difference in inpatient costs (−$2940, p < 0.0001) comprised 48.7 % of the difference in total medical costs among the two cohorts, followed by the difference in skilled nursing facility costs, which accounted for 32.9 % (−$1986, p < 0.0001) of the overall all-cause medical cost differential.Fig. 5

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