Early identification and treatment of Alzheimer's disease: social and fiscal outcomes

Abstract

Background: Alzheimer's disease (AD) is a progressive neurodegenerative disease that places substantial burdens on those who provide support for family members with declining cognitive and functional abilities. Many AD patients eventually require formal long-term care services because of the absence, exhaustion, or inability of family members to provide care. The costs of long-term care, and especially nursing home care, often deplete private financial resources, placing a substantial burden on state Medicaid programs. Current evidence suggests that pharmacological treatments and caregiver interventions can delay entry into nursing homes and potentially reduce Medicaid costs. However, these cost savings are not being realized because many patients with AD are either not diagnosed or diagnosed at late stages of the disease, and have no access to Medicare-funded caregiver support programs.

Methods and results: A Monte Carlo cost-benefit analysis, based on estimates of parameters available in the medical literature, suggests that the early identification and treatment of AD have the potential to result in large, positive net social benefits as well as positive net savings for states and the federal government.

Conclusions: These findings indicate that the early diagnosis and treatment of AD are not only socially desirable in terms of increasing economic efficiency, but also fiscally attractive from both state and federal perspectives. These findings also suggest that failure to fund effective caregiver interventions may be fiscally unsound.

Summary of modeling strategy for Monte Carlo trials

Fig. 1

Distribution of 10,000 trials of Monte Carlo analysis, showing net social benefits of diagnosis and treatment of 70-year-old married women with MMSE score of 26 at diagnosis.

Fig. 2

Net social and fiscal benefits of diagnosis and treatment of 70-year old married women diagnosed at different stages of AD (A–C), as defined by MMSE score.

Fig. 3

Net social and fiscal benefits of diagnosis and treatment of married women with MMSE score of 26 (A–C), diagnosed at different ages.