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Tuesday, 17 October 2006
11

CHANGES IN HEALTHCARE UTILIZATION FOLLOWING ALZHEIMER DISEASE TREATMENT INITIATION IN MANAGED CARE

Ann S. M. Harada, PhD, MPH, BA and Ann M. Vanderplas, MS. Prescription Solutions, Irvine, CA

Purpose: The total cost of Alzheimer's disease (AD) is estimated to range from $50-$100 billion annually. This study examined the changes in overall healthcare utilization following treatment initiation with five AD regimens: donepezil, galantamine, rivastigmine, memantine, and memantine plus acetylcholinesterase inhibitor (AChEI) combination while controlling for potential confounding factors. Methods: Retrospective analysis of medical, pharmacy and eligibility data for members initiating AD therapy (index date) between 1/1/04 and 6/30/04 from a large managed care organization (MCO) in the United States. Members who were not continuously enrolled throughout the 6-month pre-index period and 6-month post-index period were excluded. Analysis of covariance (ANCOVA) was used to determine the change (post-index period minus pre-index period) in overall pharmacy utilization, outpatient physician visits, emergency room (ER) visits, acute hospitalizations, acute hospitalization days, short-term skilled nursing facility (SNF) stays, and SNF days while controlling for age, gender, comorbidity (Chronic Disease Score) and baseline total healthcare charges. Results: A total of 2,461 were newly started on AD therapy; 65% were female and mean age was 80 years (SD 7.2). Treatment was initiated with donepezil (62%), memantine (14%), galantamine (11%), rivastigmine (8%), and memantine+AChEI (6%). While adjusted pharmacy utilization (PMPM) increased for each regimen (increases ranged from 0.27 to 0.51 across regimens, p=N.S.), medical utilization decreased. The largest decreases were observed in physician outpatient visits (ranging from 0.13 to 0.10 across regimens, p=N.S.), acute hospitalization days (0.27 to 0.11, p=N.S.), and SNF days (0.49 to 0.04, p=0.013). Conclusions: AD treatment initiation was associated with increases in overall pharmacy utilization and decreases in medical utilization, most notably in physician office visits, acute hospitalization LOS, and SNF LOS. Short-term SNF LOS was the only type of utilization that differed significantly between AD regimens.

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See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)