Assessing the Preparedness of the U.S. Health Care System Infrastructure for an Alzheimer's Treatment

Liu, Jodi L.; Hlávka, Jakub P.; Hillestad, Richard; Mattke, Soeren

doi:10.7249/rr2272

Cited by 82 publications

(140 citation statements)

References 6 publications

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“…∗Projected numbers obtained from the RAND report for US health care system readiness for an Alzheimer's disease–modifying therapy; projections for five European countries were of similar magnitude, with an estimated 14.3 M patients in those health care systems screening positive for mild cognitive impairment (data not shown) [8,9]. …”

Section: Resultsmentioning

confidence: 99%

“…Patients below the threshold might be appropriate for close monitoring (i.e., “watchful waiting”) and reassessment at follow‐up visits. Such targeted referrals to specialists or Aβ testing may be necessary to reduce burden and increase access to those patients who are most likely to benefit [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…To estimate the potential impact of the algorithm on referrals to specialists or Aβ confirmation testing, the performance metrics from MCSA validation were applied to the numbers of patients projected to be in the health care system for possible SCD or MCI due to AD on approval of a disease‐modifying therapy for AD [8,9].…”

Section: Methodsmentioning

confidence: 99%

“…Although biomarkers for Aβ and tau pathology are often used to diagnose AD in research settings, these biomarkers are not typically used to diagnose AD in routine clinical practice today, primarily owing to resource limitations and costs [1]. If a new therapy targeting AD pathology were to become available, methods to confirm the presence of AD pathology, including positron emission tomography (PET) imaging—the only US Food and Drug Administration–approved biomarker for AD—and cerebrospinal fluid (CSF) measures, are projected to remain inaccessible to many patients [1,8,9]. As such, practical methods to determine which patients are most likely to benefit from more invasive and costly confirmatory biomarker testing for the presence of AD pathology may be helpful for prioritizing potentially limited resources.…”

Section: Introductionmentioning

confidence: 99%

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Practical algorithms for amyloid β probability in subjective or mild cognitive impairment

Maserejian

Bian

Wang

et al. 2019

Alz & Dem Diag Ass & Dis Mo

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Introduction Practical algorithms predicting the probability of amyloid pathology among patients with subjective cognitive decline or mild cognitive impairment may help clinical decisions regarding confirmatory biomarker testing for Alzheimer's disease. Methods Algorithm feature selection was conducted with Alzheimer's Disease Neuroimaging Initiative and Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing data. Probability algorithms were developed in Alzheimer's Disease Neuroimaging Initiative using nested cross‐validation accompanied by stratified subsampling to obtain 1000 internally validated decision trees. Semi‐independent validation was conducted using Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing. Independent external validation was conducted in the population‐based Mayo Clinic Study of Aging. Results Two algorithms were developed using age and normalized immediate recall z‐scores, with or without apolipoprotein E ε4 carrier status. Both algorithms had robust performance across data sets and when substituting different recall memory tests. Discussion The statistical framework resulted in robust probability estimation. Application of these algorithms may assist in clinical decision‐making for further testing to diagnose amyloid pathology.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Practical algorithms for amyloid β probability in subjective or mild cognitive impairment

Maserejian

Bian

Wang

et al. 2019

Alz & Dem Diag Ass & Dis Mo

View full text Add to dashboard Cite

show abstract

“…Without changes to the structure of the U.S. health care system, however, access to new treatments for Alzheimer's may be severely restricted by capacity constraints. For example, one group of researchers developed a model of capacity constraints that estimated that individuals would wait an average of 19 months for treatment in 2020 if a new treatment is introduced by then 591 . Under this model, approximately 2.1 million individuals with MCI due to Alzheimer's disease would develop Alzheimer's dementia between 2020 and 2040 while on waiting lists for treatment.…”

Section: Use and Costs Of Health Care Long‐term Care And Hospicementioning

confidence: 99%

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

2,033

653

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid‐century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.

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Estimated Annual Spending on Lecanemab and Its Ancillary Costs in the US Medicare Program

et al. 2023

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Assessing the Preparedness of the U.S. Health Care System Infrastructure for an Alzheimer's Treatment

Cited by 82 publications

References 6 publications

Practical algorithms for amyloid β probability in subjective or mild cognitive impairment

Practical algorithms for amyloid β probability in subjective or mild cognitive impairment

2020 Alzheimer's disease facts and figures

Estimated Annual Spending on Lecanemab and Its Ancillary Costs in the US Medicare Program

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