Spotting Alzheimer’s Early Could Save America $7.9 Trillion

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(Bloomberg) -- Alzheimer’s disease is among the most expensive illnesses in the U.S. There’s no cure, no effective treatment and no easy fix for the skyrocketing financial cost of caring for an aging population.

Spending on care for people alive in the U.S. right now who will develop the affliction is projected to cost $47 trillion over the course of their lives, a report issued Tuesday by the Alzheimer’s Association found. The U.S. is projected to spend $277 billion on Alzheimer’s or other dementia care in 2018 alone, with an aging cohort of baby boomers pushing that number to $1.1 trillion by 2050.

Research so far has been stymied by clinical failures. By one count, at least 190 human trials of Alzheimer’s drugs have ended in failure. No company has successfully marketed a drug to treat it, though many big pharmaceutical companies, including Merck & Co. and Pfizer Inc., have tried. Biogen Inc., a company based in Cambridge, Massachusetts, saw its shares dive last month after it said it was expanding the number of participants in its trial for the drug aducanumab.

However, significant cost savings can be achieved, according to the new report, by the simple act of early diagnosis. Currently, individuals are typically diagnosed in the dementia stage, rather than when they have developed only mild cognitive impairment [MCI]. Identifying the disease early can allow it to be better managed, in part with existing drugs that treat its symptoms. In doing so, the study postulates, America could save $7.9 trillion over the lifetimes of everyone alive right now.

The Alzheimer’s Association commissioned researchers at Precision Health Economics to study the potential savings of obtaining an earlier diagnosis. It used data from the Health and Retirement Study, a “nationally representative sample of adults age 50 and older” run by the University of Michigan and supported by the National Institute on Aging and the Social Security Administration.

The $7.9 trillion in savings was derived from a scenario in which all adults who develop Alzheimer’s receive an early diagnosis in the MCI stage. The cumulative cost in such a circumstance is projected at $39.2 trillion—far below the $47.1 trillion that would be spent under current diagnostic patterns.

“We know that there’s a spike in medical spending around the time of diagnosis,” said Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association. “It’s actually quite expensive to do things that way.”

“You can save a significant amount of money just through better early diagnosis,” he said.

For example, managed dementia is less expensive to treat because it reduces the chances of missing medication or incurring avoidable costs, Fargo said. It’s more costly to be diagnosed in the later stages because that’s likely to occur only after an expensive trip to the hospital.

The cost of caring for Americans with Alzheimer’s will rise by $20 billion this year, compared with 2017 spending. That doesn’t include the burden that falls on unpaid caregivers such as family and friends, who last year provided 18.4 billion hours of unpaid care—which the report estimated to be the financial equivalent of $232.1 billion. The hours were calculated based on a follow-up analysis of results from the 2009 National Alliance for Caregiving/AARP national telephone survey, multiplied by an an average of the federal minimum wage and the mean hourly wage of home health aides.

Even worse is the reality that the disease’s prevalence will rise over the coming decades. There are now an estimated 5.5 million Americans aged 65 or older with Alzheimer’s. In 2025, that number is projected to be 7.1 million. By 2050, it could reach 13.8 million.

Along with the increasing costs, the report also found Alzheimer’s to be increasingly lethal. It’s currently the sixth-leading cause of death in the U.S., and deaths attributed to it jumped by 123 percent from 2000 to 2015, the report found. During the period, the number of deaths from heart disease—the top killer among Americans—decreased by 11 percent, the Alzheimer’s Association said.

While early diagnosis is a good first step, Fargo emphasized that scientific research is the only way to solve this growing health crisis. “I really think that’s a key call to action,” he said. 

©2018 Bloomberg L.P.

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