Foregone Net Monetary Benefit From Underdiagnosis and Undertreatment of Mild Cognitive Impairment Due to Alzheimer’s Disease in the Medicare Population
Author(s)
Tianzhou Yu, PhD, MS, MPH, Matthew Davis, MA, Zachary Marcum, PharmD, PhD, MS, Scott Johnson, MHA, PhD.
Medicus Economics, LLC, Milton, MA, USA.
Medicus Economics, LLC, Milton, MA, USA.
OBJECTIVES: Despite availability of disease-modifying therapies (DMTs) for Alzheimer's disease (AD), low rates of both diagnosis of mild cognitive impairment (MCI) and undertreating indicated patients imply lost value. We estimated the net monetary benefit (NMB) lost from these factors in the US Medicare program.
METHODS: National Alzheimer's Coordinating Center data for patients with at least two visits over age 65 were used to estimate transitional probabilities for a health state transition model with severity states defined by Clinical Dementia Rating, long-term care (LTC) institutionalization, and death. Diagnostic, cost, and health utility inputs came from literature review. The model took a societal perspective, excluding DMT price and discounting at 3% annually. Patients began the model with undiagnosed MCI prior to AD. Base case assumptions included an MCI diagnosis rate of 7.1%, a 30% progression rate reduction from DMTs, and 5% of indicated patients receiving DMT. NMB was compared to a scenario where the MCI diagnosis rate was 60.5%, equivalent to the current AD diagnosis rate, and all indicated patients received treatment. Quality-adjusted life-years (QALYs) were monetized at $150,000. Sensitivity analysis assessed discontinuation owing to adverse events or other factors and variation in treatment effect.
RESULTS: For a 65-year-old with MCI, improving MCI diagnosis and maximizing the DMT treatment rate would yield an additional 0.71 years in MCI and an identical reduction of time in AD or death, increasing direct medical costs by $2,582 and reducing LTC and indirect costs by $2,784 and $8,647. QALYs improved by 0.23, yielding an NMB of $42,950 per patient. Within 65-and-older Medicare patients with MCI, these changes would produce approximately $56 billion in NMB, including 333,036 QALYs. Sensitivity analysis yielded estimates ranging from $44 billion to $104 billion.
CONCLUSIONS: Increasing diagnosis and treatment of MCI with DMTs would yield substantial benefits for Medicare beneficiaries in more QALYs and lower costs.
METHODS: National Alzheimer's Coordinating Center data for patients with at least two visits over age 65 were used to estimate transitional probabilities for a health state transition model with severity states defined by Clinical Dementia Rating, long-term care (LTC) institutionalization, and death. Diagnostic, cost, and health utility inputs came from literature review. The model took a societal perspective, excluding DMT price and discounting at 3% annually. Patients began the model with undiagnosed MCI prior to AD. Base case assumptions included an MCI diagnosis rate of 7.1%, a 30% progression rate reduction from DMTs, and 5% of indicated patients receiving DMT. NMB was compared to a scenario where the MCI diagnosis rate was 60.5%, equivalent to the current AD diagnosis rate, and all indicated patients received treatment. Quality-adjusted life-years (QALYs) were monetized at $150,000. Sensitivity analysis assessed discontinuation owing to adverse events or other factors and variation in treatment effect.
RESULTS: For a 65-year-old with MCI, improving MCI diagnosis and maximizing the DMT treatment rate would yield an additional 0.71 years in MCI and an identical reduction of time in AD or death, increasing direct medical costs by $2,582 and reducing LTC and indirect costs by $2,784 and $8,647. QALYs improved by 0.23, yielding an NMB of $42,950 per patient. Within 65-and-older Medicare patients with MCI, these changes would produce approximately $56 billion in NMB, including 333,036 QALYs. Sensitivity analysis yielded estimates ranging from $44 billion to $104 billion.
CONCLUSIONS: Increasing diagnosis and treatment of MCI with DMTs would yield substantial benefits for Medicare beneficiaries in more QALYs and lower costs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE478
Topic
Economic Evaluation
Disease
Mental Health (including addition), Neurological Disorders