DELAYING DECLINE, REDUCING DEMAND: NEAR-TERM UTILIZATION AND COSTS ASSOCIATED WITH PROGRESSION OF ALZHEIMER’S DISEASE AMONG US MEDICARE BENEFICIARIES
Author(s)
Victor Finomore, PhD1, Marc W. Haut, PhD1, Camila Vieira Ligo Teixeira, PhD1, Holly Phelps, PhD1, Kathleen A. Troeger, MPH2;
1Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA, 2Cognito Therapeutics, Cambridge, MA, USA
1Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA, 2Cognito Therapeutics, Cambridge, MA, USA
OBJECTIVES: To quantify differences in healthcare utilization and Medicare spending between early-stage and mid-stage patients with Alzheimer’s disease (AD), Alzheimer’s disease related disorders (ADRD), or Mild Cognitive Impairment (MCI) in the first year post-diagnosis and estimate economic value associated with delaying progression by one year.
METHODS: A retrospective cohort study was conducted using Medicare Fee-for-Service and Dual-Eligible beneficiaries within the CMS Innovator dataset (accessed 11/19/2025). Patients with a first qualifying ICD-10 diagnosis of AD/ADRD/MCI between 2021-2022 were included, with exclusions for incomplete data and death and a 12-month lookback period (n=1,387,310). In lieu of adequate coding, a utilization-based grading algorithm inclusive of sentinel events served to classify patients into early-, mid-, and late-stages of disease progression. Sg2 Life Sciences provided data assets and analytic support used in this analysis.Healthcare utilization and Medicare allowed payments for the study period were aggregated over the first 12 months following diagnosis. Outcomes included average encounters per beneficiary and average Medicare payment per encounter across multiple settings: inpatient, skilled nursing facility (SNF), emergency department (ED), hospital outpatient department and physician office. Medicare allowed payments estimated payer spending.
RESULTS: When comparing the early-stage cohort with the mid-stage cohort, we observed an increase in high-acuity resource utilization: the number of ED encounters increased from 27 to 77 per 100 patients (2.9×), inpatient encounters increased from 7 to 68 per 100 patients (9.7×), and SNF encounters increased from 5 to 92 per 100 patients (18.4×). Cumulatively, utilization differences across settings = $73,934 higher cost per mid-stage patient compared to an early-stage patient in the first 12 months.
CONCLUSIONS: The transition from early to mid-stage AD/ADRD/MCI represents an economic inflection point, characterized by increases in high-acuity resource utilization and Medicare spending. Early identification with interventions that delay progression, has the potential to yield near-term cost offsets for payers and health systems.
METHODS: A retrospective cohort study was conducted using Medicare Fee-for-Service and Dual-Eligible beneficiaries within the CMS Innovator dataset (accessed 11/19/2025). Patients with a first qualifying ICD-10 diagnosis of AD/ADRD/MCI between 2021-2022 were included, with exclusions for incomplete data and death and a 12-month lookback period (n=1,387,310). In lieu of adequate coding, a utilization-based grading algorithm inclusive of sentinel events served to classify patients into early-, mid-, and late-stages of disease progression. Sg2 Life Sciences provided data assets and analytic support used in this analysis.Healthcare utilization and Medicare allowed payments for the study period were aggregated over the first 12 months following diagnosis. Outcomes included average encounters per beneficiary and average Medicare payment per encounter across multiple settings: inpatient, skilled nursing facility (SNF), emergency department (ED), hospital outpatient department and physician office. Medicare allowed payments estimated payer spending.
RESULTS: When comparing the early-stage cohort with the mid-stage cohort, we observed an increase in high-acuity resource utilization: the number of ED encounters increased from 27 to 77 per 100 patients (2.9×), inpatient encounters increased from 7 to 68 per 100 patients (9.7×), and SNF encounters increased from 5 to 92 per 100 patients (18.4×). Cumulatively, utilization differences across settings = $73,934 higher cost per mid-stage patient compared to an early-stage patient in the first 12 months.
CONCLUSIONS: The transition from early to mid-stage AD/ADRD/MCI represents an economic inflection point, characterized by increases in high-acuity resource utilization and Medicare spending. Early identification with interventions that delay progression, has the potential to yield near-term cost offsets for payers and health systems.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE246
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Geriatrics, SDC: Neurological Disorders