(393) Incremental Healthcare Costs of Psychoses and Agitation/Aggression among Medicare Beneficiaries with Alzheimer’s Disease

Background: : A particularly challenging aspect of Alzheimer’s disease (AD) is the frequent occurrence of neuropsychiatric symptoms such as psychoses and agitation/aggression. In the absence of effective treatments—antipsychotics are often used despite well-known side effects and limited efficacy—these symptoms can substantially increase costs.

Objective: : To estimate the incremental healthcare costs associated with neuropsychiatric symptoms in a national sample of patients covered by Medicare, the primary payer for AD care in the US.

Methods: : This cross-sectional analysis used 2022 Medicare fee-for-service claims to identify adults with ≥1 inpatient or ≥2 outpatient claims with a diagnosis of AD, continuous Medicare Parts A, B, and D enrollment during the year, and no evidence of bipolar disorder or schizophrenia. Based on ≥1 inpatient or ≥2 outpatient claims with relevant ICD-10 codes, four mutually exclusive groups were created: AD with psychoses, AD with agitation/aggression, AD with both, and AD without either (i.e., control group). All-cause and AD-related costs (adjusted to 2024 USD) were reported. Multivariable generalized linear models estimated adjusted incremental costs for psychosis alone, agitation/aggression alone, and both symptoms relative to patients without either, controlling for sociodemographic and clinical covariates.

Results: : The final sample included 272,685 beneficiaries with AD: 4,785 (1.8%) with psychoses, 70,200 (25.7%) with agitation/aggression, 14,904 (5.5%) with both, and 182,796 (67.0%) without either. Characteristics were similar across the four study groups (mean age 82.5-83.5 years; 67.3–74.8% female; 82.4–85.4% White). Compared to patients without neuropsychiatric symptoms, risk-adjusted all-cause costs were higher in patients with psychoses ($37,733; Δ=$5,577; p<.0001), agitation/aggression ($39,029; Δ=$6,131; p<.0001), and both symptoms ($45,523; Δ=$12,974; p<.0001). Similarly, risk-adjusted AD-related costs were higher in patients with psychoses ($11,038; Δ=$1,311; p<.0001), agitation/aggression ($14,048; Δ=$3,996; p<.0001), and both symptoms ($16,108; Δ=$6,185; p<.0001).

Conclusions: : Among Medicare beneficiaries with AD, psychoses and agitation/aggression are associated with significantly higher healthcare costs. These findings underscore the economic burden of these symptoms and the need for more effective and better-tolerated treatments. As AD prevalence grows, targeted treatments for psychosis and agitation/aggression may offer important clinical and economic benefits.

Sponsorship:: AbbVie, Inc.