Megan Brooks

July 26, 2016

TORONTO ― For patients with Alzheimer's disease (AD), early treatment with currently recommended medications may prolong survival and save healthcare dollars, compared with nontreatment, according to a longitudinal retrospective study.

"The arguments for early treatment are myriad, but this study shows greater survival and less all-cause healthcare costs among those receiving treatment for dementia," Christopher M. Black, MPH, from Merck Research Laboratories, said in a statement.

"These results indicate that choosing not to treat, or even a delay in starting treatment, may lead to less favorable results. Early diagnosis and time to treatment should be a priority for policy makers, physicians, and the public," Black noted.

He presented the study findings at a press briefing here at the Alzheimer's Association International Conference (AAIC) 2016.

Positive Economic, Patient Impact

Few studies have assessed the effects of existing antidementia drug therapies on the economy and mortality in comparison with no treatment in patients in the United States who have been newly diagnosed with Alzheimer's disease, Black explained.

To investigate, the study team identified 6553 incident cases of Alzheimer's disease from Medicare fee-for-service claims data over a 2-year period. Three quarters of the patients were women. They were categorized as being either treated and nontreated on the basis of whether they were prescribed an existing AD drug after diagnosis. The patients were followed until death, disenrollment, or the end of the study period.

Common first treatments for those patients receiving treatment were donepezil (multiple brands, 66.8%), memantine (Namenda, Forest Labs, 18.5%), rivastigmine (Excelon, Novartis, 12.5%), and galantamine (Razadyne, Janssen, 2.0%).

Compared with treated patients, untreated patients were generally older and had more comorbid conditions. In addition, the unadjusted death rate during the study period was higher for patients receiving treatment than for untreated patients.

In a propensity score-matched cohort of 694 treated and 694 untreated patients, survival was better for the treated patients (hazard ratio, 0.72; P = .0079), and they had fewer hospice visits (0.04 vs 0.09; P = .0001) and lower monthly all-cause costs ($2207 vs $2349, P = .3037) in comparison with untreated patients.

For all patients, average healthcare costs more than tripled in the first month after an AD diagnosis. But patients receiving Alzheimer's medication had lower overall health carecosts in the month they were diagnosed compared with those who did not receive a treatment ($5535 vs $6711).

Following the month of diagnosis, healthcare costs decreased, but the average cost per patient per month remained considerably higher than baseline. The biggest driver of cost was inpatient care, which made up 30% of the total expenditures for both treated and untreated patients.

The study also showed that only 35% of patients were prescribed an antidementia drug after their diagnosis.

"The new results support that early Alzheimer's treatment ― even with today's first-generation therapies ― has significant potential to benefit the person with the disease, and the economy," said Maria C. Carrillo, PhD, chief science officer for the Alzheimer’s Association, in a conference statement.

"Today, Alzheimer's is incurable and progressive, and some assume that treating dementia is an unjustified cost drain on our healthcare system, but this study presents compelling arguments for prescribing the standard of care," she added.

In an interview with Medscape Medical News, Dr Carrillo said this is an important study because "right now, we think of standard of care as not as effective as we'd like, and some people actually question whether Alzheimer's treatments are effective at all in their loved one. This study, along with others in the past that have shown delayed institutionalization with treatment, shows that there is some benefit to current standard of care."

This study, she added, shows that "treatment actually can make a difference in mortality. It's important for neurologists to know this because there is some sense of nihilism in the field in general with standard of care."

The study had no commercial funding. The authors have disclosed no relevant financial relationships.

Alzheimer's Association International Conference (AAIC) 2016. Abstract O2-11-02. Presented July 25, 2016.

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