AUTHOR
Author(s)
Bella Vo, PharmD, MS1, Sabrina Wang, PharmD1, Chintan Dave, PharmD, PhD2;
1Rutgers School of Public Health, New Brunswick, NJ, USA, 2Rutgers University, New Brunswick, NJ, USA
1Rutgers School of Public Health, New Brunswick, NJ, USA, 2Rutgers University, New Brunswick, NJ, USA
OBJECTIVES: Alzheimer’s disease and related dementias (ADRD) impose a growing clinical, epidemiological, and economic burden in the US, underscoring the need for understanding real-world treatment patterns. This study aimed to characterize treatment patterns and temporal trends in the use of ADRD medications among US Medicare beneficiaries.
METHODS: This serial cross-sectional study used a 50% sample of Medicare fee-for-service data between January 1, 2011 and December 31, 2021. In each calendar year, beneficiaries with continuous enrollment were eligible if they had a diagnosis of ADRD and ≥1 prescription fill for an ADRD medication (PPV >95%). Beneficiaries with any enrollment in Medicare Advantage plans or a long-term nursing home stay were excluded.
RESULTS: The analysis included 1,319,158 eligible ADRD episodes corresponding to 775,783 unique beneficiaries (mean [SD] age, 81.5 [7.2] years), of whom 63.8% were female. From 2011 to 2021, donepezil was the most dispensed agent, with use increasing from 48% to 54% (p<0.001 for trend), while memantine utilization remained relatively stable (36-38%). Galantamine and rivastigmine were infrequently prescribed (<12% in any given year). The annual number of prescription claims for ≥2 distinct ADRD agents increased nearly 2.8-fold, from 32,326 in 2011 to 89,184 in 2021. Combination therapy was dominated by donepezil plus memantine, accounting for 62.8% of combination use in 2011 and 79.7% in 2021. Off-label antipsychotic use without a corresponding diagnosis of psychiatric conditions remained notable but declined from 24.3% in 2011 to 19.6% in 2021.
CONCLUSIONS: ADRD pharmacotherapy in Medicare remained dominated by donepezil and memantine, while combination therapy increased nearly threefold and was largely donepezil-memantine. Antipsychotic use without documented psychiatric disorder persisted, highlighting ongoing safety and prescribing-quality concerns.
METHODS: This serial cross-sectional study used a 50% sample of Medicare fee-for-service data between January 1, 2011 and December 31, 2021. In each calendar year, beneficiaries with continuous enrollment were eligible if they had a diagnosis of ADRD and ≥1 prescription fill for an ADRD medication (PPV >95%). Beneficiaries with any enrollment in Medicare Advantage plans or a long-term nursing home stay were excluded.
RESULTS: The analysis included 1,319,158 eligible ADRD episodes corresponding to 775,783 unique beneficiaries (mean [SD] age, 81.5 [7.2] years), of whom 63.8% were female. From 2011 to 2021, donepezil was the most dispensed agent, with use increasing from 48% to 54% (p<0.001 for trend), while memantine utilization remained relatively stable (36-38%). Galantamine and rivastigmine were infrequently prescribed (<12% in any given year). The annual number of prescription claims for ≥2 distinct ADRD agents increased nearly 2.8-fold, from 32,326 in 2011 to 89,184 in 2021. Combination therapy was dominated by donepezil plus memantine, accounting for 62.8% of combination use in 2011 and 79.7% in 2021. Off-label antipsychotic use without a corresponding diagnosis of psychiatric conditions remained notable but declined from 24.3% in 2011 to 19.6% in 2021.
CONCLUSIONS: ADRD pharmacotherapy in Medicare remained dominated by donepezil and memantine, while combination therapy increased nearly threefold and was largely donepezil-memantine. Antipsychotic use without documented psychiatric disorder persisted, highlighting ongoing safety and prescribing-quality concerns.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD108
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Geriatrics, SDC: Neurological Disorders