Healthcare Resource Utilization for Patients With Alzheimer's Disease Versus Non-Alzheimer's Disease Controls in Israel

OBJECTIVES: To characterize healthcare resource utilization for patients between 10 years pre- and 2 years post-Alzheimer’s disease (AD) diagnosis in Israel.

METHODS: This longitudinal, retrospective cohort study used the de-identified Maccabi Healthcare Services (MHS) database and included adult patients diagnosed with AD (ICD-9 code 331.0 or corresponding MHS internal codes). Date of first AD diagnosis (Index date, ID) occurred between January 1, 2010–December 31, 2019. Patients with continuous enrollment for ≥1 year pre- and ≥2 years post-ID (excluding death) were analyzed. MHS members without AD diagnosis were matched to patients with AD by age, sex, and socioeconomic status (controls). Between-group comparison was performed using standardized mean difference (SMD), time to event was assessed using Kaplan-Meier Curves and log-rank test.

RESULTS: 44,128 individuals (22,064 with AD diagnosis and 22,064 controls) were included. From 3 years pre-ID, a higher proportion of patients with AD experienced ≥1 hospitalization compared to controls; the greatest difference occurred in the year pre-ID (33.5% vs 20.8%, SMD≥0.1). This trend continued 2 years post-ID (32.5% vs 23.5%, SMD≥0.1). Among patients not hospitalized pre-ID, hospitalization post-ID occurred sooner among patients diagnosed with AD than controls (p<0.001). At 1 year pre- and post-ID, mean hospitalization days were greater among patients diagnosed with AD than controls by a margin of 1.7 and 2.1 days, or 0.8 and 0.7 days after adjustment for confounders. At 1 year post-ID, mean healthcare costs (including cost of hospitalization days, emergency or outpatients’ visits, and medication purchases) were $2647 greater among patients diagnosed with AD than controls, or $825 after adjustment for confounders.

CONCLUSIONS: Among patients in the MHS database, greater proportions of patients diagnosed with AD experienced ≥1 hospitalization and increased healthcare costs, compared with matched controls. These data indicate that AD is associated with increased healthcare resource utilization in Israel, even before diagnosis.