Rezaul Karim Khandker

Economic Burden, Mortality, and Institutionalization in Patients Newly Diagnosed with Alzheimer’s Disease

BACKGROUND Current information is scarce regarding comorbid conditions, treatment, survival, institutionalization, and health care utilization for Alzheimers disease (AD) patients. OBJECTIVES Compare all-cause mortality, rate of institutionalization, and economic burden between treated and untreated newly-diagnosed AD patients. METHODS Patients aged 65-100 years with ≥1 primary or ≥2 secondary AD diagnoses (ICD-9-CM:331.0] with continuous medical and pharmacy benefits for ≥12 months pre-index and ≥6 months post-index date (first AD diagnosis date) were identified from Medicare fee-for-service claims 01JAN2011-30JUN2014. Patients with AD treatment claims or AD/AD-related dementia diagnosis during the pre-index period were excluded. Patients were assigned to treated and untreated cohorts based on AD treatment received post-index date. Total 8,995 newly-diagnosed AD patients were identified; 4,037 (44.8%) were assigned to the treated cohort. Time-to-death and institutionalization were assessed using Cox regression. To compare health care costs and utilizations, 1 : 1 propensity score matching (PSM) was used. RESULTS Untreated patients were older (83.85 versus 81.44 years; p < 0.0001), with more severe comorbidities (mean Charlson comorbidity index: 3.54 versus 3.22; p < 0.0001). After covariate adjustment, treated patients were less likely to die (hazard ratio[HR] = 0.69; p < 0.0001) and were associated with 20% lower risk of institutionalization (HR = 0.801; p = 0.0003). After PSM, treated AD patients were less likely to have hospice visits (3.25% versus 9.45%; p < 0.0001), and incurred lower annual all-cause costs (

REAL WORLD ADMINISTRATION OF THE ALZHEIMER’S DISEASE ASSESSMENT SCALE-COGNITIVE

25,828 versus

Analysis of Episodes of Care in Medicare Beneficiaries Newly Diagnosed with Alzheimer's Disease: Episodes of Care in Alzheimer's Disease

30,110; p = 0.0162). CONCLUSION After controlling for comorbidities, treated AD patients have better survival, lower institutionalization, and sometimes fewer resource utilizations, suggesting that treatment and improved care management could be beneficial for newly-diagnosed AD patients from economic and clinical perspectives.

THE RELATIVE FREQUENCY OF DEMENTIA-RELATED DIAGNOSES AMONG INCIDENT ALZHEIMER’S DISEASE PATIENTS COMPARED WITH CONTROLS IN COMMERCIAL AND MEDICARE SUPPLEMENTAL DATABASES

Background: The Alzheimer’s disease assessment scale-cognitive (ADAS-Cog) is the preferred efficacy measure in Alzheimer’s disease (AD) clinical trials but is rarely used in real-world practice ADAS-cog data generated in the real-world could be used to facilitate a better understanding of the clinical and economic meaningfulness of ADAS-cog changes observed during trials. The objective of this analysis was to estimate the frequency of ADAS-cog use in the real-world and describe the characteristics of administering physicians and their patients. Methods: Data were taken from the 2015/16 Adelphi RealWorld Dementia Disease Specific Programme, a cross-sectional survey of physicians, and their patients with cognitive impairment (CI) in the UK, France, Italy, Germany, Spain, Canada and the US. Physicians completed interviews about their clinical knowledge and practice setting and also completed record forms, containing patient demographics, clinical characteristics, diagnosis and tests/scales performed to aid diagnosis. Results: While 71% (n1⁄4534) of all physicians surveyed (n1⁄4757) were aware of the ADAS-Cog, only 40% (n1⁄4211) used the ADAS-Cog in clinical practice with varying levels of frequency: 9.5% very often, 22.4% often, 52.4% occasionally and 15.7% rarely. Physicians who administered the ADAS-Cog were more likely to be neurologists (48.8% vs. 37.6%, p1⁄40.0410), deliver care at memory clinics (50.5% vs. 25.5%, p<0.0001), or were currently involved in CI/dementia clinical trials (10.6% vs.

DETERIORATING COGNITION ASSOCIATED WITH HIGHER LEVELS OF INSTUTIONALIZATION IN JAPAN

To study transitions between healthcare settings and quantify the cost burdens associated with different combinations of transitions during a 6‐month period before initial Alzheimers disease (AD) diagnosis so as to investigate how using an episode‐of‐care approach to payment for specific disease states might apply in AD.

PREVALENCE OF DIAGNOSED SYMPTOMS PRECEDING ALZHEIMER’S DISEASE DIAGNOSIS AMONG TREATED AND UNTREATED ALZHEIMER’S DISEASE PATIENTS WITH COMMERCIAL AND MEDICARE SUPPLEMENTAL INSURANCE

relationships adjusting for age, sex, education and ApoE4 status. Results: There were 124 people with T2D (mean age 75.5 years, SD 6.2) and 693 without T2D (mean age 75.1 years, SD 6.9) with at least 1 MRI available. Overall, the sample had a low burden of cerebrovascular disease based on Hachinski score. At each follow up, those who did not undergo an MRI were more likely to have AD and lower cortical thickness at baseline than those who remained in the study (all p<0.001). T2D was not directly associated with a greater rate of decline in cortical thickness or cognitive function. T2D was associated with lower baseline cortical thickness (p1⁄40.012). Lower baseline cortical thickness was associated with a greater rate of cognitive decline (p<0.001). There was an indirect effect of T2D on decline in cognitive function via baseline cortical thickness (p1⁄40.026). These associations changed minimally when adjusted for baseline cognitive diagnosis. Conclusions: T2D may indirectly contribute to neurodegeneration and cognitive decline even in the setting of low cerebrovascular risk.

DETERIORATING MMSE SCORE ASSOCIATED WITH HIGHER LEVELS OF INSTUTIONALIZATION IN AUSTRALIA

PATIENT Work for pay, n (%) yes 138 (21.3) 65 (10.0) 91 (15.4) 83 (15.0) 58 (20.6) 33 (10.7) 60 (23.3) 23 (7.8) Reduced work due to health, n (%) 84 (16.5) 119 (20.6) 78 (15.8) 102 (21.7) 35 (15.8) 43 (15.8) 34 (17.3) 67 (24.8) Cut down hours due to AD, n (%) 5 (3.6) 9 (13.8) 5 (5.5) 6 (7.2) 2 (3.4) 3 (9.1) 1 (1.7) 5 (21.7) Re-entered work force to supplement income for loss due to declining cognition, n (%) 9 (6.5) 10 (15.4) 10 (11.0) 6 (7.2) 5 (8.6) 5 (15.2) 2 (3.3) 4 (17.4)

THE RACE TO DIAGNOSE: DISEASE SEVERITY AS A FACTOR OF ALZHEIMER’S DISEASE DIAGNOSIS

COGNITIVE IMPAIRMENT TO ALZHEIMER DISEASE Ta-Fu Chen, Ya-Fang Chen, Rwei-Fen S. Huang, Ming-Jang Chiu, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; Fu-Jen Catholic University, Taipei County, Taiwan; National Taiwan University Hospital, Taipei, Taiwan. Contact e-mail: chentf@ms4.hinet.net

HEALTH CARE USE AMONG NEWLY DIAGNOSED ALZHEIMER’S DISEASE PATIENTS IN A U.S. DATABASE OF EMPLOYER-SPONSORED MEDICARE SUPPLEMENT INSURANCE PLANS

Background:Although there is no cure for Alzheimer’s disease (AD), there are medications that ameliorate symptoms, some of which may occur prior to AD diagnosis. This retrospective cohort analysis aims to describe the potential healthcare cost implications of the timing of treatment initiation relative to AD diagnosis. Methods: Newly diagnosed AD patients were identified in the January 2010 – December 2016 Truven Health MarketScan Commercial and Medicare Supplemental Databases and stratified by payer type: commercial (50-64 years) and Medicare (65-100 years). Study patients were required to have continuous medical and pharmacy benefits enrollment for 36 months prior to, and 12 months following, the first AD diagnosis and no evidence of vascular dementia or other severe neuropsychiatric conditions during the preceding 36 months. Patients were categorized into four sub-cohorts based on the sequence of initial diagnosis and treatment: diagnosed but no treatment; concurrent diagnosis and treatment (within +/60 days), treatment first (treatment >60 days prior to diagnosis); diagnosis first (treatment >60 days after diagnosis). Total perpatient per-year all-cause healthcare costs were measured during the 36 months preceding and the 12 months following the first AD diagnosis. Results:A total of 2,372 treated and 944 untreated commercial patients, and 55,598 treated and 20,504 untreated Medicare patients were included in the analysis. Treatment first was the most common treatment sequence (Commercial: 49%; Medicare: 62%). Mean annual total healthcare costs are presented in figure 1. In both cohorts, treated patients who received concurrent treatment incurred the lowest costs during the 36 months preceding and the 12 months following the initial diagnosis. in the Medicare cohort, untreated patients followed by those who were diagnosed first (i.e. received treatment at least 60 days later) incurred the highest costs in the 12 months following diagnosis. In the commercial cohort, untreated patients followed by those who received treatment first incurred the highest costs both before and after treatment. Conclusions:These results demonstrate that initiating treatment at the time of initial diagnosis is associated with lower costs. Understanding the optimal timing of treatment initiation for clinical and cost outcomes is important for informing disease management strategies. P3-600 DETERIORATING MMSE SCORE ASSOCIATEDWITH HIGHER LEVELS OF INSTUTIONALIZATION IN AUSTRALIA Christopher M. Black, Eddie Jones, Rezaul Karim Khandker, Joseph Husbands, James Pike, Baishali M. Ambegaonkar, Michael Woodward, Merck&Co., Inc., Kenilworth, NJ, USA; Adelphi Real World, Macclesfield, United Kingdom; Austin Health, Melbourne, Australia. Contact e-mail: christopher. black2@merck.com

EPISODES OF CARE AMONG MEDICARE ELIGIBLE ALZHEIMER’S DISEASE PATIENTS DIAGNOSED IN INPATIENT SETTINGS IN THE UNITED STATES

vs. 87.5 per 100 person-years). Number of planned admissions didn’t differ between the dementia subtypes, but DLB patients had more frequent of emergency admissions. We detected a strong association between DLB and hospitalization, which remained significant after adjusting for a wide range of confounders (hazard ratio: 1.59; 95% CI: 1.19-2.13). DLB patients had more admissions due to Parkinsonian symptoms, atrial fibrillation, constipation and delirium. Conclusions: DLB patients are more frequently admitted to hospital as emergencies and utilize inpatient care to a substantially higher degree than AD patients or the general older population. It would be important to assess whether hospitalizations can be reduced by identifying DLB earlier and providing more targeted outpatient care.