Dementia Has a Substantial Impact on the Prevalence and Costs of Comorbid Conditions That Are Potentially Modifiable by Care Management

This release was prepared by the study authors. For more information, read a summary by lead author Patricia Salber, MD, MBA, at The Doctor Weighs In.

November 12, 2018—The prevalence and costs of 15 comorbid conditions deemed modifiable by care management were measurably higher in patients with Alzheimer’s disease and other dementias (ADOD) compared with those without, according to a study published in The American Journal of Managed Care^®.

The multidisciplinary team of researchers tested the hypothesis that the inability of patients with ADOD to manage modifiable comorbid conditions would have a significant impact on their healthcare costs. The results were based on a cross-sectional retrospective analysis of a 5% Medicare claims data set.

Unlike prior studies that examined differences in costs between those with and without ADOD while controlling for comorbidities, this study was designed to explore the actual magnitude of selected comorbidities in this population. “Our goals were two-fold,” said epidemiologist and corresponding author Thomas Wilson, PhD, DrPH, “(1) to compare the prevalence and cost of modifiable comorbid conditions of nearly 100,000 ADOD patients to a matched group of Medicare beneficiaries without ADOD; and (2) to use statistical techniques to rank which condition(s)—when targeted by care managers—would likely achieve the biggest benefit in population health management strategies.”

The authors found that 9.4% of individuals in the entire sample had at least one ADOD-related claim and were linked to 22.8% of total healthcare costs. After 1:1 matching, patients with ADOD represented 50% of the sample but 70% of the costs. Fractures, urinary tract infections, and uncomplicated diabetes were the comorbid conditions that were linked to the highest population costs in those with ADOD.

“Efforts to reduce costs of managing patients with ADOD require more effective management of certain costly comorbid conditions, in addition to management of the neurological disorder,” said lead author Dr. Patricia Salber. “Failure to accurately identify all individuals with ADOD will lead to a significant missed opportunity unless we target this costly population and more effectively manage the whole patient and their comorbid conditions.”

Further studies are required to better understand how ADOD impacts and likely exacerbates comorbid conditions that are modifiable with care management.