Pharmaceutical Use and Spending Trend in Medicare Beneficiaries With Dementia, From 2006 to 2012

Abstract

Objectives: The aim of the study was to examine the trend in incidence and prevalence of dementia, use and spending of antidementia and antipsychotic drugs among dementia patients. Methods: Using 2006-2012 Medicare claims data, we identified individuals with diagnosis of dementia and collected their pharmacy claims in 2006-2012. We built regression models to test the trend in number of prescriptions and spending on antidementia, antipsychotic, and other drugs. Results: The prevalence of dementia did not change during our study period. Spending on antidementia and antipsychotic drugs creased to increase in 2011, following the patent expiration of Aricept, Zyprexa, and Seroquel; and total pharmaceutical spending did not change in 2006-2012. Use of antidementia drugs increased during our study period; however, the off-label use of antipsychotic drugs did not decrease. Discussion: Pharmaceutical spending associated with dementia may not be as concerning for Medicare as previously thought; nevertheless, policies that discourage the nonevidence-based off-label use of drugs are warranted.

Keywords: dementia; health services; medications; policy.

Figure 1.

Trend in the prevalence and incidence of Alzheimer’s disease and other forms of dementia. Note. Incidence was calculated as the ratio between the number of new patients diagnosed with the condition during the year of analysis, and the number of Medicare Part D beneficiaries in the 5% random sample. Prevalence was calculated as the ratio between the number of total patients, which include new patients and existing patients—who were diagnosed with the condition before January 1 of the year of study—and the number of Medicare Part D beneficiaries in the 5% random sample. Patients with other dementia includes patients with Alzheimer’s disease related disorders and senile dementia. The p values indicate the p value for the annual slope change and were obtained from ordinary least squares regression models.

Figure 2.

Mean annualized pharmaceutical spending and counts of monthly prescriptions filled for antidementia and antipsychotic drugs per patient diagnosed with Alzheimer’s disease or other forms of dementia. Note. (a) Mean annualized spending for antidementia drugs and antipsychotic agents per patient, by type of dementia and year. (b) Mean annualized number of monthly prescriptions filled for antidementia and antipsychotic drugs per patient, by type of dementia and year. Patients with other dementia include patients with Alzheimer’s disease related disorders and senile dementia.

Figure 3.

Mean annualized pharmaceutical spending and counts of monthly prescriptions for antidementia and antipsychotic drugs per patient diagnosed with Alzheimer’s disease or other forms of dementia and no diagnosis of FDA-approved indications of antipsychotic drugs. Note. (a) Mean annualized off-label spending for antipsychotic agents per patient, by type of dementia and year. (b) Mean annualized number of monthly prescriptions filled off-labelly for antipsychotic drugs per patient, by type of dementia and year. FDA = Food and Drug Administration.