COST OF ILLNESS AMONG ALZHEIMER’S DISEASE AND RELATED DEMENTIAS (ADRD) MEDICARE PATIENTS IN THE UNITED STATES BETWEEN 2011-2021
Author(s)
Sabrina Wang, PharmD1, Bella Vo, PharmD2, Chintan Dave, PharmD, PhD3;
1Rutgers Health - Center for Health Outcomes, Policy, and Economics, Post-Doctoral Fellow, New Brunswick, NJ, USA, 2Rutgers School of Public Health, Pennington, NJ, USA, 3Rutgers University, New Brunswick, NJ, USA
1Rutgers Health - Center for Health Outcomes, Policy, and Economics, Post-Doctoral Fellow, New Brunswick, NJ, USA, 2Rutgers School of Public Health, Pennington, NJ, USA, 3Rutgers University, New Brunswick, NJ, USA
OBJECTIVES: Alzheimer’s disease and related dementias (ADRD) impose a substantial and growing economic burden on the U.S. healthcare system, particularly within Medicare. However, contemporary and nationally representative estimates of both all-cause and ADRD-attributable healthcare costs remain outdated or limited. This study evaluated secular trends in all-cause and ADRD-specific direct healthcare costs among Medicare beneficiaries with ADRD from 2011 to 2021.
METHODS: A serial cross-sectional, prevalence-based study was conducted using Medicare Parts A, B, and D claims. For each calendar year, community-dwelling beneficiaries aged ≥65 years with continuous enrollment were identified using claims-based criteria for ADRD. Annual healthcare costs were aggregated across inpatient, outpatient, and prescription drug claims and adjusted to 2021 U.S. dollars. Costs were categorized as total, out-of-pocket (OOP), and ADRD-specific costs.
RESULTS: The study included 2,233,606 beneficiaries with ADRD (mean age 81.5 years; 35.6% male). Mean annual all-cause healthcare costs declined modestly from $16,219 in 2011 to $15,309 in 2013, increasing year-over-year thereafter, and approaching $17,063 in 2021. This increase was primarily driven by outpatient medical spending, which rose from $5,842 to $7,203 and became the dominant cost component over time, while inpatient and pharmacy costs remained stable or declined. In contrast, overall OOP costs decreased over the decade, falling from $2,121 to $1,822, driven by reductions in pharmacy and inpatient cost sharing despite rising outpatient OOP spending. ADRD-specific costs increased from $4,548 in 2011 to $5,000 in 2021, driven by inpatient and outpatient spending, while ADRD-specific pharmacy costs fell from $1,898 to $568, reflecting the availability of off-patent ADRD therapies.
CONCLUSIONS: Among Medicare beneficiaries with ADRD, overall healthcare costs increased over the past decade, with a notable shift toward outpatient and ADRD-specific medical services. Although patient OOP costs declined overall, rising outpatient expenditures highlight evolving cost pressures.
METHODS: A serial cross-sectional, prevalence-based study was conducted using Medicare Parts A, B, and D claims. For each calendar year, community-dwelling beneficiaries aged ≥65 years with continuous enrollment were identified using claims-based criteria for ADRD. Annual healthcare costs were aggregated across inpatient, outpatient, and prescription drug claims and adjusted to 2021 U.S. dollars. Costs were categorized as total, out-of-pocket (OOP), and ADRD-specific costs.
RESULTS: The study included 2,233,606 beneficiaries with ADRD (mean age 81.5 years; 35.6% male). Mean annual all-cause healthcare costs declined modestly from $16,219 in 2011 to $15,309 in 2013, increasing year-over-year thereafter, and approaching $17,063 in 2021. This increase was primarily driven by outpatient medical spending, which rose from $5,842 to $7,203 and became the dominant cost component over time, while inpatient and pharmacy costs remained stable or declined. In contrast, overall OOP costs decreased over the decade, falling from $2,121 to $1,822, driven by reductions in pharmacy and inpatient cost sharing despite rising outpatient OOP spending. ADRD-specific costs increased from $4,548 in 2011 to $5,000 in 2021, driven by inpatient and outpatient spending, while ADRD-specific pharmacy costs fell from $1,898 to $568, reflecting the availability of off-patent ADRD therapies.
CONCLUSIONS: Among Medicare beneficiaries with ADRD, overall healthcare costs increased over the past decade, with a notable shift toward outpatient and ADRD-specific medical services. Although patient OOP costs declined overall, rising outpatient expenditures highlight evolving cost pressures.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE247
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Geriatrics, SDC: Neurological Disorders