Megan Brooks

November 11, 2015

BARCELONA — A new study highlights the financial toll on individuals and families when a loved one is diagnosed with amnestic mild cognitive impairment (aMCI).

The study shows a statistically significant linear increasing trend in annual direct medical spending and decreasing trend in annual household income in adults with aMCI relative to those with normal cognition. However, aMCI was associated with significantly less medical spending and greater household income compared with Alzheimer's disease (AD) dementia.

The study findings were reported at the 8th Clinical Trials Conference in Alzheimer's Disease (CTAD).

"Much research has gone into understanding the financial burden of dementia and AD," study author Suepattra G. May-Slater, PhD, MPH, from Precision Health Economics, Los Angeles, California, told Medscape Medical News. Far less is known about the economic burden of MCI.

The purpose of the study was to understand the burden specifically from aMCI "in order to understand the potential value of effective early interventions that may delay AD onset and progression," Dr May-Slater explained.

"We took advantage of the in-home battery of neurocognitive tests and the clinical consensus panel for diagnosis available in the Aging, Demographics, and Memory Study (ADAMS) to identify aMCI and AD. Our data came from the baseline ADAMS survey conducted between 2001 and 2003. Our costs were inflated to 2015 US dollars," Dr May-Slater said.

The analysis included 121 individuals with amnestic MCI, 174 with probable or possible AD (mild, moderate, or severe), and 316 cognitively normal adults.

The researchers assessed annual direct medical spending (hospital, nursing home, doctor visits, dental visits, outpatient surgeries, prescription drugs, home healthcare, special facilities), total annual household income (for both respondent and spouse: earnings, pensions, annuities, social security disability, veteran benefits, security retirement), and spouse's income. They used linear regression models to assess the association between cognitive status (normal, MCI, AD [mild, moderate, severe]) and financial burden, adjusting for demographic characteristics. They used sampling weights to obtain representative estimates for the US elderly population.

Worse cognitive status was associated with increasing age (P < .001), female sex (P = .02), lower education (P < .001), being single (P = .008), and nonwhite race (P < .001), the research team says.

After adjustment for demographic characteristics, annual direct medical spending was $6233 lower in cognitively normal adults than in those with aMCI. Annual direct medical spending was $45,673, $38,918, and $130,207 lower in adults with aMCI relative to those with mild, moderate, and severe AD (linear trend: P < .001), the authors report.

Across all cognitive status categories, the researchers also observed a statistically significant decreasing linear trend for annual household income (P = .019), with an average decrease of $5067, and a decreasing nonsignificant linear trend in annual income for the spouse (–$420).

The findings from this study "provide valuable data for healthcare professionals, payers, policymakers, patients and their families to understand the potential value of effective early interventions that may delay AD disease progression," the authors conclude.

Important Contribution

Reached for comment on the study, Matthew Baumgart, senior director of public policy at the Alzheimer's Association, noted that "very few studies have looked at the economics of MCI, so this is an important contribution."

"We have long known that people with Alzheimer's have much higher health and long-term care costs; this study suggests that the economic burden of cognitive impairment starts hitting families even before the onset of the disease. That said, the bottom line of this new study is that people with MCI have higher annual healthcare costs than people with normal cognition, but still significantly less than people who have Alzheimer's disease," he said.

"It is imperative that the federal government invest more in Alzheimer's research. A treatment that delays the onset of Alzheimer's — that delays progression from MCI to dementia — will generate significant savings for both Medicare and families," Baumgart told Medscape Medical News.

The study was sponsored by Genentech. The authors have disclosed no relevant financial relationships.

8th Clinical Trials Conference on Alzheimer's Disease (CTAD). Poster P3-3. Presented November 7, 2015.

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