(367) Healthcare costs associated with timely diagnosis of mild cognitive impairment and Alzheimer's Disease

Background: : Mild cognitive impairment (MCI) and Alzheimer's disease (AD) affect millions of Americans. MCI, characterized by cognitive decline with intact daily living activities, progresses to AD, where functional independence declines. Understanding the cost implications and progression rates of these conditions, particularly in relation to the timing and setting of diagnosis, is crucial for optimizing patient outcomes and managing healthcare expenditures.

Objective: : Estimate longitudinal costs and time to death, disease progression, and institutionalization associated with MCI and AD.

Methods: : This retrospective, observational, case-control study utilized Medicare Research Identifiable Files from 2016 to 2021. Patients aged 65 and older with at least 24 months of continuous Medicare enrollment were included and categorized into incident MCI or AD cohorts if there were no diagnosis codes for either condition in the prior 12 months. Subjects with an MCI or AD diagnosis were matched to non-diagnosed controls using set criteria. Costs and time-to- institutionalization and -death were assessed using Kaplan-Meier survival analysis and regression models.

Results: : The incident cohorts included 422,866 individuals with MCI and 560,313 with AD diagnoses. At 24 months post-index diagnosis, the survival probability was 65% v. 84% (p < 0.05) for MCI and 33% v. 71% (p < 0.05) for AD compared to their respective matched controls. Average costs for subjects with MCI|AD during the index month were approximately $27,071|$20,186 for the inpatient setting, $17,069|$14,039 for the institutional setting, and $3,520|$3,409 for the outpatient setting. A sub-analysis comparing incident MCI subjects to matched AD subjects found that monthly per subject costs were $552 lower for the MCI cohort compared to their AD matched cohort.

Conclusions: : Healthcare expenditures were significantly higher for individuals diagnosed in inpatient or institutional settings compared to diagnosis in outpatient settings. Diagnosis at an earlier stage (MCI) was associated with lower initial and long-term costs and increased probability of survival compared to those at a later stage (AD). These results underscore the potential benefits of timely diagnosis in appropriate settings to reduce the economic burden of dementia. Timely diagnosis of MCI and AD significantly reduces healthcare costs, enhances survival, and delays institutionalization. The findings of this study emphasize the need for strategies promoting early and outpatient diagnosis for those with MCI or AD to potentially improve patient outcomes and reduce healthcare expenditures.

Sponsorship:: Eli Lilly & Company