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Currently, more than 6 million adults in the United States have Alzheimer's disease and related dementia (ADRD)
.
Current estimates suggest that the cost of ADRD is Medicare (Parts A and B) ranging from $3,019 to $10,598 per person per year (2017 dollars)
Medicaid, the public insurance program for low-income people and the primary payer of long-term care in the U.
S.
, is often overlooked for its costs
.
Because ADRD is characterized by cognitive impairment that results in difficulties with daily activities, the cost of long-term care can be considerable
Four reports estimated the cost of Medicaid nationwide, relying on self-reported usage and imputed Medicaid spending
.
Medicare and Medicaid
Apart from the incompleteness of estimated costs, the literature has largely focused on estimating costs based on prevalent cases
.
Popular cost estimates are useful for understanding current expenditures, but have limited use in predicting future costs if the case mix is changing, or if the cost of the disease changes over the course of the disease
The incidence of ADRD is declining in high-income countries, leading to changes in the case mix, and there is evidence that dementia-related costs vary widely depending on the time since diagnosis or the time before death
.
From this, Norma B.
Coe et al.
of the University of Pennsylvania estimated the incremental cost of ADRD to public finances in the first 5 years after diagnosis through Medicare (Parts A, B, and D) and Medicaid
.
They estimated total spending and spending by cost component (inpatients, prescription drugs, nursing home and home health care, and others) to see which usage was driving costs
.
Using data from the Health and Retirement Study matched to Medicare and Medicaid reimbursement, they identified a retrospective cohort of adults with reimbursement-based ADRD diagnoses, as well as matched controls
.
In the first 5 years after diagnosis, ADRD cost per dementia case was $15,632 and Medicaid was $8,833
.
.
70% of Medicare costs are incurred in the first two years; Medicaid costs are concentrated on longer-lived beneficiaries who are more likely to need long-term care and be covered by Medicaid
.
Medium implications of this study: Since the distribution of incremental costs varies over time and insurance programs , when an intervention occurs, and how it affects the disease process, will have an impact on how much and which program gets the benefit
.
Source:
Coe NB, White L, Oney M, Basu A, Larson EB.
Public spending on acute and long‐term care for Alzheimer's disease and related dementias.
Alzheimer's & Dementia.
Public spending on acute and long‐term care for Alzheimer's disease and related dementias.
Alzheimer's & Dementia.
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