Pharmaceutical Treatment for Alzheimer’s Disease and Related Dementias: Utilization and Disparities

Jun 16, 2020Journal of Alzheimer's disease : JAD

Use and Differences in Drug Treatment for Alzheimer's Disease and Similar Dementias

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Abstract

Among persons diagnosed with ADRD or related symptoms, 33.3% used an approved drug over the study period.

The odds of using an approved antidementia drug were higher among Whites compared to non-Whites.
Forty percent of users began treatment within 6 months of their initial diagnosis of ADRD or related symptoms.
Sixteen percent of users initiated treatment prior to receiving a diagnosis.
Disparities in treatment initiation were observed by race/ethnicity, with 28% of Asians, 24% of Hispanics, 16% of Blacks, and 15% of Whites starting treatment before diagnosis.
The overall use of antidementia drugs is relatively low among older Americans.

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BACKGROUND: Four prescription drugs (donepezil, galantamine, memantine, and rivastigmine) are approved by the US FDA to treat symptoms of Alzheimer's disease (AD). Even modest effectiveness could potentially reduce the population-level burden of AD and related dementias (ADRD), especially for women and racial/ethnic minorities who have higher incidence of ADRD.

OBJECTIVE: Describe the prevalence of antidementia drug use and timing of initiation relative to ADRD diagnosis among a nationally representative group of older Americans, and if there are disparities in prevalence and timing by sex and race/ethnicity.

METHODS: Descriptive analyses and logistic regressions of Medicare claims (2008-2016) for beneficiaries who had an ADRD or dementia-related symptom diagnosis, or use of an FDA approved drug for AD. We investigate prevalence of use and timing of treatment initiation relative to ADRD diagnosis across time and beneficiary characteristics (age, sex, race/ethnicity, socioeconomic status, comorbidities).

RESULTS: Among persons diagnosed with ADRD or related symptoms, 33.3% used an approved drug over the study period. Odds of use was higher among Whites than non-Whites. Among ADRD drug users, 40% initiated use within 6 months of the initial ADRD or related symptoms diagnosis, and 16% initiated prior to a diagnosis. We observed disparities by race/ethnicity: 28% of Asians, 24% of Hispanics, 16% of Blacks, and 15% of Whites initiated prior to diagnosis.

CONCLUSIONS: The use of antidementia drugs is relatively low and varies widely by race/ethnicity. Heterogeneity in timing of initiation and use may affect health and cost outcomes, but these effects merit further study.

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Pharmaceutical Treatment for Alzheimer’s Disease and Related Dementias: Utilization and Disparities

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