A real-world assessment of healthcare costs associated with agitation in Alzheimer’s dementia

Abstract

Aims

To describe and compare clinical characteristics, healthcare costs, and institutionalization/mortality outcomes among patients with and without agitation associated with Alzheimer’s dementia (AAD).

Methods

Data from the Reliant Medical Group database (01/01/2016-03/31/2020) were used, including claims, electronic medical records, and clinical information/physician notes abstracted from medical charts. Patients aged ≥55 years with Alzheimer’s dementia (AD) were observed during a randomly selected 12-month study period after AD diagnosis. Using information recorded in medical charts, patients were classified into cohorts based on experiencing (agitation cohort) and not experiencing (no agitation cohort) agitated behaviours during the study period. Entropy balancing was used to create reweighted cohorts with similar characteristics. Study outcomes (patient demographic and clinical characteristics, treatments received, healthcare costs, institutionalization and death events) were compared between cohorts; agitation characteristics were described for the agitation cohort only.

Results

Among 711 patients included in the study, 240 were classified in the agitation cohort and 471 in the no agitation cohort. After reweighting, several comorbidities were more frequently observed in the agitation versus no agitation cohort, including infection, depression, and altered mental status. Use of antidepressants, anticonvulsants, antipsychotics, and antianxiety medications was more common in the agitation versus no agitation cohort. Common agitated behaviours included hitting (20.8%), pacing/aimless wandering (17.5%), and cursing/verbal aggression (15.0%). Total all-cause healthcare costs were $4287 per-patient-per-year higher in the agitation cohort versus no agitation cohort (p = 0.04), driven by higher inpatient costs. Death was more common and time to death and institutionalization were shorter in the agitation versus no agitation cohort.

Limitations

Results may not be generalizable to the US population with AD.

Conclusions

Among patients with AD, agitation was associated with shorter time to death/institutionalization and increased comorbidities, medication use, and healthcare costs, highlighting the additional clinical and economic burden that agitation poses to patients and the healthcare system.

Keywords:

• Agitation
• alzheimer’s dementia
• economic burden
• healthcare costs
• medication use

JEL CLASSIFICATION CODES:

• I11
• I1
• I
• I00
• I

Transparency

Declaration of funding

This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck LLC.

Declaration of financial/other relationships

GG served as a clinical consultant to Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck LLC at the time of study completion. AU is an employee of Lundbeck LLC. JS and JA are employees of Otsuka Pharmaceutical Development & Commercialization, Inc. RB, MC, MGL, DC, and AG are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Otsuka Pharmaceutical Development & Commercialization, Inc., which funded the development and conduct of this study and manuscript.

Author contributions

RB, MC, MGL, DC, and AG contributed to study conception and design, collection and assembly of data, and data analysis and interpretation. GG, AU, JS, and JA contributed to study conception and design, data analysis and interpretation. All authors reviewed and approved the final content of this manuscript.

Acknowledgements

Medical writing support was provided by a professional medical writer, Christine Tam, MWC, an employee of Analysis Group, Inc.

Data availability statement

Data is not available due to legal restrictions. Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available. Therefore, restrictions apply to the availability of these data, which are not publicly available.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they are a consultant at IQVIA. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Previous presentations

Part of the material in this manuscript was presented at the International Society for Pharmacoeconomics and Outcomes Research 2023 Annual Conference, held on May 7–10 in Boston, MA, USA, as a poster presentation.