Care Dependency and Sick Leave Patterns in Early Alzheimer's Disease: A Retrospective Claims Data Analysis in Germany
Author(s)
Christian Jacob, Dr.1, Elke Mathey, M.Comp.Sc.2, Laura Fang, Dr.2, Christopher Maas, MSc1, Timotheus Stremel, MSc1, Roland Fliedner, Dr.3, Marlena Schnieder, PD Dr.3, Christine von Arnim, Prof. Dr.3.
1Cencora, Hannover, Germany, 2Novo Nordisk Pharma GmbH, Mainz, Germany, 3University of Goettingen Medical Center, Goettingen, Germany.
1Cencora, Hannover, Germany, 2Novo Nordisk Pharma GmbH, Mainz, Germany, 3University of Goettingen Medical Center, Goettingen, Germany.
OBJECTIVES: Alzheimer's disease is a progressive neurodegenerative disorder that poses significant burden on patients and healthcare systems. This study investigates care dependency levels and sick leave patterns in individuals with early AD using German real-world data.
METHODS: This retrospective, non-interventional study used claims data from the InGef research database (2014-2022). Early AD was defined as de-novo prescriptions of AChE inhibitor (AChEIs: donepezil, galantamine, or rivastigmine) in individuals aged ≥50 years (index), without memantine prescriptions within 100-days. Two independent cohorts were constructed: a pre-cohort (2022) to assess changes longitudinally up to 8 years before; and a post-cohort (2017) up to 5 years after index. Both cohorts were matched 1:1 to control patients without any signs of AD. Care dependency was assessed annually using German OPS codes defining levels of care (1: minor; 2-3: moderate to severe, 4-5 highest care needs), alongside sick leave episodes and related ICD-10 diagnoses.
RESULTS: In total, 1,997 pre-cohort patients and 2,051 post-cohort patients were analysed. In the pre-cohort, 15.1% had documented care by year -1 (vs. 5.3% in controls; p<0.001), compared to 0% in year -8 (both patients and controls). In the post-cohort care prevalence increased from 21.7% in year 1 to 26.2% in year 5, significantly exceeding controls (2.7% and 7.5%; p<0.001 for both years). Most patients in the post-cohort had care level 2 in year 1 (9.3%), progressing to levels 3 and 4 by year 5 (both 9.8%). Sick leave rates were comparable in year -8 (24.1% vs. 25.4%; p=0.701) but higher for the pre-cohort by year -1 (17.8% vs. 13.5%; p=0.324), with depressive episodes being notably more frequent in patients (1.5%) vs. controls (0.7%, p=0.0298).
CONCLUSIONS: Care dependency emerges early in AD. Sick leave - especially related to psychiatric comorbidities - may serve as early indicators. Earlier recognition and intervention may delay care dependency and preserve independence.
METHODS: This retrospective, non-interventional study used claims data from the InGef research database (2014-2022). Early AD was defined as de-novo prescriptions of AChE inhibitor (AChEIs: donepezil, galantamine, or rivastigmine) in individuals aged ≥50 years (index), without memantine prescriptions within 100-days. Two independent cohorts were constructed: a pre-cohort (2022) to assess changes longitudinally up to 8 years before; and a post-cohort (2017) up to 5 years after index. Both cohorts were matched 1:1 to control patients without any signs of AD. Care dependency was assessed annually using German OPS codes defining levels of care (1: minor; 2-3: moderate to severe, 4-5 highest care needs), alongside sick leave episodes and related ICD-10 diagnoses.
RESULTS: In total, 1,997 pre-cohort patients and 2,051 post-cohort patients were analysed. In the pre-cohort, 15.1% had documented care by year -1 (vs. 5.3% in controls; p<0.001), compared to 0% in year -8 (both patients and controls). In the post-cohort care prevalence increased from 21.7% in year 1 to 26.2% in year 5, significantly exceeding controls (2.7% and 7.5%; p<0.001 for both years). Most patients in the post-cohort had care level 2 in year 1 (9.3%), progressing to levels 3 and 4 by year 5 (both 9.8%). Sick leave rates were comparable in year -8 (24.1% vs. 25.4%; p=0.701) but higher for the pre-cohort by year -1 (17.8% vs. 13.5%; p=0.324), with depressive episodes being notably more frequent in patients (1.5%) vs. controls (0.7%, p=0.0298).
CONCLUSIONS: Care dependency emerges early in AD. Sick leave - especially related to psychiatric comorbidities - may serve as early indicators. Earlier recognition and intervention may delay care dependency and preserve independence.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD20
Topic
Health Service Delivery & Process of Care
Disease
Geriatrics, Neurological Disorders