OBJECTIVES: To assess the incremental economic burden of agitation in patients with Alzheimer’s dementia (AD) in the United States.

METHODS: Data from the Reliant Medical Group database (01/01/2016-03/31/2020) were used, including claims data, electronic medical records, and detailed clinical information abstracted from patient medical charts. Patients aged ≥55 years diagnosed with AD were identified and observed during a randomly selected 12-month study period sometime after the AD diagnosis. Patients were classified as experiencing and not experiencing agitated behaviors based on information recorded in their medical charts during the study period. Entropy balancing was used to create reweighted cohorts with similar characteristics. All-cause and AD-related healthcare costs (including medical and pharmacy costs) were assessed during the study period and compared between cohorts using weighted regressions models.

RESULTS: After reweighting, patients in the agitation cohort (N=240) and no agitation cohort (N=471) had similar mean age (85 years) and proportions of female (66.7%) and moderate to severe AD (42.5%). The most frequently recorded agitated behaviors were physically and verbally aggressive behaviors (40.4%) and physically non-aggressive behaviors (38.8%). Over the study period, patients in the agitation cohort incurred 20.7% greater all-cause healthcare costs (difference: $4,624, p<0.05), mostly driven by higher inpatient costs (difference: $2,227, p<0.05). For both cohorts, AD-related costs accounted for the majority of healthcare costs (agitation cohort: 68.9%, no agitation cohort: 53.1%). Although patients with agitation were more likely to be treated with antipsychotics or antidepressants, there was no statistically significant difference in pharmacy costs (difference: $284, p=0.20).

CONCLUSIONS: Among patients with AD, agitation was associated with increased healthcare costs, highlighting the additional burden that agitation poses. Strategies focusing on improving agitation management have the potential to mitigate the burden associated with AD for payers and the healthcare system.