Introduction Care of individuals with Alzheimer’s Disease and Related Dementias (ADRD) poses special challenges. As the disease progresses, individuals with ADRD require increasing levels of medical care, caregiver support, and long-term care which can lead to substantial economic burden. Areas covered In this expert review, we synthesized findings from studies of costs of ADRD in the United States that were published between January 2006 and February 2017, highlighted major sources of variation in costs, identified knowledge gaps and briefly outlined directions for future research and implications for policy and program planning. Expert commentary A consistent finding of all studies comparing individuals with and without ADRD is that the average medical, non-medical, and indirect costs of individuals with ADRD are higher than those without ADRD, despite the differences in the methods of identifying ADRD, duration of the study, payer type and settings of study population. The economic burden of ADRD may be underestimated because many components such as direct non-medical costs for home safety modifications and adult day care services and indirect costs due to the adverse impact of ADRD on caregivers’ health and productivity are not included in cost estimates.

Objective To estimate the excess direct annual healthcare expenditures associated with Alzheimer's and related dementias(ADRD) among community-dwelling older adults in the United States. Methods This retrospective cross-sectional study compared the annual healthcare expenditures between elderly individuals aged 65 years and older with ADRD (n = 662) and without ADRD (n = 13,398) using data from the Medical Expenditure Panel Survey (MEPS) for the years 2007, 2009, 2011 and 2013. Adjusted total annual medical expenditures was estimated using generalized linear model with gamma distribution and log link in 2013 U.S. dollars. Adjusted inpatient, outpatient, emergency, home healthcare and prescription drug expenditures, were estimated using two-part logit-generalized linear regression models. Results The adjusted mean total healthcare expenditures were higher for the ADRD group as compared to the no ADRD group($14,508 vs. $10,096). Among those with ADRD, 34.3% of the expenditures were for home healthcare as compared to 4.4% among those without ADRD. Among users, the ADRD group had significantly higher home healthcare ($3,240 vs. $566) and prescription drug expenditures($3,471 vs. $2,471). There were no statistically significant differences in inpatient, emergency room and outpatient expenditures between the ADRD and no ADRD group. Conclusion ADRD in U.S. community-dwelling elders is associated with significant financial burden, primarily driven by increased home healthcare use.

The prevalence of multiple chronic conditions (MCC) is increasing among individuals of all ages. MCC are associated with poor health outcomes. The presence of MCC has profound healthcare utilization and cost implications for public and private insurance payers, individuals, and families. Investigators have used a variety of definitions for MCC to evaluate costs associated with MCC. The objective of this article is to examine the current literature in estimating excess costs associated with MCC among adults. The discussion highlights some of the theoretical and technical merits of various MCC definitions and models used to estimate the excess costs associated with MCC.

Saponins, a major class of natural phytochemicals, hold great promises for being developed into chemopreventive and chemotherapeutic drugs. However, one of the major factors limiting their pharmacological effects in vivo is poor bioavailability. This paper reviews the factors that determine the absorption and bioavailability of saponins including their physicochemical properties, and their absorption and disposition in the gastrointestinal tract. A critical review of the current research papers suggests that poor permeability and microflora hydrolysis of saponins are the primary factors that limit their bioavailabilities. Future investigations should be directed towards further optimization of the bioavailability of saponins to enhance their chemopreventive and chemotherapeutic effects in vivo.

Objective To examine the persistence with rapid-acting insulin (RAI) and its association with clinical outcomes among elderly patients with type 2 diabetes (T2D). Methods This observational, retrospective cohort study analyzed RAI persistence and its association with change in A1C and risk of severe hypoglycemia among elderly (≥65 years) Medicare beneficiaries with T2D who added RAI to their basal insulin regimen. Results Among T2D patients with >1 RAI prescriptions (n=3,927), only 21% were persistent. Baseline factors positively associated with RAI persistence (Adjusted Odds Ratio [95% CI]) were: age ≥75 vs 65–74 years: 1.20 [1.01–1.43]; use of ≥3 oral antidiabetes drugs: 1.63 [1.16–2.28]; cognitive impairment: 1.34 [1.03–1.73]; and A1C >9.0%: 1.58 [1.15–2.17]. Elderly T2D patients having emergency department visits (0.73 [0.59–0.91]) and higher RAI out-of-pocket costs (≥$75 vs $0 to <$6.40: 0.56 [0.44–0.70]) were less likely to be persistent. Persistent RAI users had a significantly higher reduction in A1C (beta coefficient [standard error]: −0.24 [0.10] and lower odds of severe hypoglycemia (Adjusted Odds Ratio [95% CI]): 0.73 [0.53–0.99]. Conclusion Among elderly T2D patients, persistence with RAI added to basal insulin was associated with improved glycemic control, with lower risk of severe hypoglycemia. Despite treatment effectiveness, RAI persistence was poor and might be improved by reducing RAI out-of-pocket costs.