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Kruse C, Maier F, Spottke A, Bach JP, Bartels C, Buerger K, Fellgiebel A, Fliessbach K, Frölich L, Hausner L, Hellmich M, Klöppel S, Klostermann A, Kornhuber J, Laske C, Peters O, Priller J, Richter-Schmidinger T, Schneider A, Shah-Hosseini K, Teipel S, von Arnim CAF, Wiltfang J, van der Wurp H, Dodel R, Jessen F. Apathy in patients with Alzheimer's disease is a cost-driving factor. Alzheimers Dement 2023. [PMID: 36588502 DOI: 10.1002/alz.12915] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/30/2022] [Accepted: 09/02/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Apathy is the most frequent neuropsychiatric symptom in patients with dementia of the Alzheimer's type (DAT). We analyzed the influence of apathy on the resource use of DAT patients and their caregivers. METHODS Included were baseline data of 107 DAT patients from a randomized clinical trial on apathy treatment. The Resource Utilization in Dementia (RUD) instrument assessed costs over a 1-month period prior to baseline. Cost predictors were determined via a least absolute shrinkage and selection operator (LASSO). RESULTS On average, total monthly costs were €3070, of which €2711 accounted for caregivers' and €359 for patients' costs. An increase of one point in the Apathy Evaluation Scale resulted in a 4.1% increase in total costs. DISCUSSION Apathy is a significant cost driving factor for total costs in mild to moderate DAT. Effective treatment of apathy might be associated with reduced overall costs in DAT.
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Affiliation(s)
- Christopher Kruse
- Department of Geriatric Medicine, Center for Translational Neurological and Behavioural Research, University Duisburg-Essen, Duisburg, Germany
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University of Bonn, Bonn, Germany
| | - Jan-Philipp Bach
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen (UMG), Georg-August-University, Goettingen, Germany
| | - Katharina Buerger
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Andreas Fellgiebel
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lucrezia Hausner
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Arne Klostermann
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Psychiatry, Charité Berlin, Berlin, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Psychiatry, Charité Berlin, Berlin, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Neuropsychiatry, Charité Berlin & Berlin Institute of Health, Berlin, Germany
| | - Tanja Richter-Schmidinger
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, University of Bonn, Bonn, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic Medicine, University Hospital of Rostock, Rostock, Germany
| | | | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen (UMG), Georg-August-University, Goettingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany
| | - Hendrik van der Wurp
- Department of Geriatric Medicine, Center for Translational Neurological and Behavioural Research, University Duisburg-Essen, Duisburg, Germany.,Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Richard Dodel
- Department of Geriatric Medicine, Center for Translational Neurological and Behavioural Research, University Duisburg-Essen, Duisburg, Germany.,Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Frank Jessen
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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Frazer M, Rashid N, Bunner S, Skoog B, Abler V. Burden of Illness Among Patients with Psychosis due to Dementia with Lewy Bodies and Other Dementias. Am J Alzheimers Dis Other Demen 2023; 38:15333175231163521. [PMID: 36893766 PMCID: PMC10578523 DOI: 10.1177/15333175231163521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Limited research is available on the real-world experiences of patients with dementia with Lewy bodies (DLB). This study evaluated clinical events, healthcare utilization, and healthcare costs of patients with DLB vs other dementia types with psychosis (ODP). Study patients included commercial and Medicare Advantage with Part D enrollees aged ≥40 years with evidence of DLB and ODP from 6/01/2015‒5/31/2019. Compared with patients with ODP, more patients with DLB had clinical events including anticholinergic effects, neurologic effects, and cognitive decline. Patients with DLB used more healthcare resources with greater dementia-related office and outpatient visits and psychosis-related inpatient stays and office, outpatient, and emergency visits compared with their ODP patient counterparts. Patients with DLB also incurred higher healthcare costs for all-cause and dementia-related office visits and pharmacy fills, and psychosis-related total costs. Understanding the clinical and economic impact of DLB and ODP is important to improve care for patients with dementia.
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Affiliation(s)
| | | | | | - Ben Skoog
- Acadia Pharmaceuticals, San Diego, CA, USA
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Forns J, Danysh HE, McQuay LJ, Turner ME, Dempsey C, Anthony MS, Demos G, Layton JB. Clinical outcomes and treatment patterns of older adults with dementia-related psychosis by dementia type in the United States. BMC Geriatr 2022; 22:784. [PMID: 36203129 PMCID: PMC9541053 DOI: 10.1186/s12877-022-03489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background Little is known about the incidence of clinical events and treatment patterns among older adults with dementia-related psychosis. Given that dementia-related psychosis comprises various dementia types, this study describes the incidence of clinical events and treatment patterns by dementia type after patients with dementia are diagnosed with psychosis. Methods Adults aged ≥ 65 years with dementia and newly diagnosed with psychosis were identified in US Medicare claims during 2013–2018. Baseline characteristics were evaluated at the time of the psychosis diagnosis. After the initial psychosis diagnosis, incidence rates (IRs) of clinical events (e.g., falls/fractures, infections, healthcare utilization), mortality, and patterns of antipsychotic treatment were described for each dementia type (Alzheimer’s disease [AD], Parkinson’s disease dementia [PDD], dementia with Lewy bodies [DLB], frontotemporal dementia [FTD], vascular dementia [VD], and unspecified dementia). Daily mean cumulative counts were estimated to describe the incidence of recurrent events over time. Mortality was described using Kaplan–Meier survival curves. Results We identified 484,520 patients with dementia-related psychosis: mean age, 84 years (standard deviation, 7.8); female, 66%. At the time of psychosis diagnosis, the most prevalent type of dementia was unspecified dementia (56%), followed by AD (31%), VD (12%), PDD (10%), DLB (3%), and FTD (< 1%), and most patients had scores indicating severe illness on the Charlson Comorbidity Index (71%) and frailty index (62%). Across all dementia types, IRs (per 100 person-years) were high for emergency department visits, oral anti-infective use, and urinary tract infections after the initial psychosis diagnosis. Patients with DLB had the highest incidence of most clinical outcomes. After 1 year of follow-up, the cumulative probability of death was about 30% for all dementia types, and after 5 years, was about 80% among patients with DLB, VD, AD, or PDD and about 60%-65% among patients with FTD or unspecified dementia. Conclusions Patients with dementia-related psychosis had a high burden of comorbidities, frailty, emergency department visits, infections, and death. Specifically, after DRP diagnosis, patients with DLB and VD had the highest burden of clinical events of interest. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03489-3.
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Affiliation(s)
- Joan Forns
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain.
| | - Heather E Danysh
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Waltham, MA, USA
| | - Lisa J McQuay
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Mary Ellen Turner
- Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, Princeton, NJ, USA
| | - Colleen Dempsey
- Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, Princeton, NJ, USA
| | - Mary S Anthony
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA
| | - George Demos
- Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, San Diego, CA, USA
| | - J Bradley Layton
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA
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Brandt T, Frangiosa T, Biggar V, Taylor A, Valentine J, Keller B, Price M, DeMuro C, Abler V. Symptoms and Treatment Needs of People with Dementia-Related Psychosis: A Mixed-Methods Study of the Patient Experience. Clin Gerontol 2022; 45:681-695. [PMID: 34369313 DOI: 10.1080/07317115.2021.1957050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study describes the person-centered experience and impact of symptoms and the treatment needs of dementia-related psychosis (DRP) from a patient and care partner perspective. METHODS Qualitative interviews and a quantitative survey were used to collect patient experience data from persons with DRP or their care partners. RESULTS Sixteen participants (1 person with DRP, 15 care partners) completed the qualitative interview; 212 participants (26 persons with DRP, 186 care partners) completed the quantitative survey. The most commonly reported symptoms were visual hallucinations, auditory hallucinations, persecutory delusions, and distortion of senses. The most common impacts were difficulty differentiating what is real from what is not real, increased anxiety, and effects on personal relationships. Current treatments were less than moderately helpful, and the ability to distinguish what is real from what is not real and overall symptom improvement were described as the most important benefits of an ideal treatment. CONCLUSIONS Patient experience data provide insights into urgent therapeutic needs of patients by describing the nature, frequency, and severity of symptoms and the impacts they have on individuals' lives. CLINICAL IMPLICATIONS Patient experience data demonstrate an unmet need for treatments to reduce the symptoms and impacts of DRP.
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Affiliation(s)
- Teresa Brandt
- Acadia Pharmaceuticals Inc, San Diego, California, USA
| | | | | | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, USA
| | - James Valentine
- Hyman, Phelps & McNamara, P.C, Washington, DC, USA.,Carey School of Law, University of Maryland, Baltimore, Maryland, USA
| | - Bill Keller
- Acadia Pharmaceuticals Inc, San Diego, California, USA
| | - Mark Price
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Carla DeMuro
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Victor Abler
- Acadia Pharmaceuticals Inc, San Diego, California, USA
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Rashid N, Wetmore JB, Irfan M, Abler V. Economic Evaluation of Healthcare Resource Utilization and Costs for Newly Diagnosed Dementia-Related Psychosis. Geriatrics (Basel) 2022; 7:geriatrics7020029. [PMID: 35314601 PMCID: PMC8938820 DOI: 10.3390/geriatrics7020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/15/2022] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
This retrospective cohort study described changes in all-cause healthcare resource utilization (HCRU) and associated costs in dementia patients newly diagnosed with psychosis. Dementia and incident psychosis were identified using diagnostic and pharmacy claims using a Medicare 20% random sample dataset. All-cause HCRU and unweighted and weighted (by person-years of follow-up) HCRU-associated costs were evaluated in the year prior to and the 4 years following diagnosis of psychosis. In 49,509 dementia patients with psychosis, physician visits per patient per year increased from a mean of 26.7 (standard deviation (SD) 20.0) prior to psychosis to 38.4 (SD 41.9) post-psychosis diagnosis. The number of inpatient stay claims increased from 1.0 (SD 1.4) to 1.7 (SD 5.8). Mean unweighted costs for inpatient stays and home healthcare/hospice during 2008–2016 were USD 9989 and USD 3279 prior to a diagnosis of psychosis but increased to USD 25,982 and USD 9901 (weighted: USD 11,779 and USD 6709), respectively, in the year after a psychosis diagnosis. This pattern of a sharp increase in mean costs was also observed in costs adjusted to 2015 USD, and in both unweighted and weighted total and psychosis-related costs. These results indicate the importance of identifying newly diagnosed psychosis in dementia patients as well as the pressing need for management strategies and treatments that can reduce HCRU and costs.
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Affiliation(s)
- Nazia Rashid
- Acadia Pharmaceuticals Inc., San Diego, CA 92130, USA;
- Correspondence: ; Tel.: +1-858-558-2871
| | - James B. Wetmore
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN 55415, USA;
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
| | - Muna Irfan
- Veterans Affairs Medical Center, University of Minnesota, Minneapolis, MN 55417, USA;
| | - Victor Abler
- Acadia Pharmaceuticals Inc., San Diego, CA 92130, USA;
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