Abstract
Objectives
There is currently no accurate profile of the economic burden of dementia with Lewy
bodies (DLB), particularly any examination of the direct medical costs of DLB by the
number of affected clinical domains. Understanding how trends in the use of healthcare
resources evolve as DLB progresses presents opportunities for the development of earlier
and more appropriate interventions.
Design
Retrospective study using claims data extracted from the IBM MarketScan Commercial
and Medicare Supplemental database.
Setting and Participants
In total, 536 patients with DLB from the Commercial database and 5485 patients with
DLB from the Medicare Supplemental database.
Methods
Patients were grouped into disease complexity categories based on core clinical features
(ie, fluctuating cognition, motor symptoms, visual hallucinations, and rapid eye movement
sleep behavior disorder in addition to dementia) observed during the study period:
dementia with no core features observed, dementia plus 1, 2, or ≥3 core features,
respectively. Outcome measures included healthcare resource utilization and healthcare
costs.
Results
In both databases, total healthcare resource utilization and costs increased with
number of core features. Compared with patients with no core features observed, patients
in all other complexity categories had significantly higher mean medical visits and
costs in both adjusted and unadjusted analyses. Fluctuating cognition was associated
with the highest total costs, suggesting that this clinical feature in particular
is associated with a considerable economic burden.
Conclusions and Implications
Analyzing direct medical costs of DLB by disease complexity using claims data showed
that a higher cost impact was associated with increasing number of clinical domains
affected and with specific clinical domains, suggesting the need for both targeted
and comprehensive interventions to improve the overall economic burden of DLB.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Alzheimer's Association series on understanding dementia.2019 (Available at:) (Accessed July 23, 2020)
- The state of the art of dementia research. New frontiers.Alzheimer’s Disease International (ADI), London2018
- What is LBD?.(2019. Available at:) (Accessed February 1, 2020)
- Clinical prevalence of Lewy body dementia.Alzheimers Res Ther. 2018; 10: 19
- Comprehensive treatment of dementia with Lewy bodies.Alzheimer Res Ther. 2015; 7: 45
- Dementia with Lewy bodies: Diagnosis and management for primary care providers.Prim Care Companion CNS Disord. 2011; 13 (PCC.11r01190)
- Low sensitivity in clinical diagnoses of dementia with Lewy bodies.J Neurol. 2010; 257: 359-366
- Practical suggestions on how to differentiate dementia with Lewy bodies from Alzheimer's disease with common cognitive tests.Int J Geriatr Psychiatry. 2009; 24: 1405-1412
- A systematic review of prevalence and incidence studies of dementia with Lewy bodies.Age Ageing. 2005; 34: 561-566
- The prevalence and incidence of dementia with Lewy bodies: A systematic review of population and clinical studies.Psychol Med. 2014; 44: 673-683
- The prevalence and incidence of dementia with Lewy bodies: A systematic review.Can J Neurol Sci. 2016; 43: S83-S95
- Dementia with Lewy bodies: Diagnosis and management.Int J Geriatr Psychiatry. 2001; 16: S12-S18
- Lewy body dementias.The Lancet. 2015; 386: 1683-1697
- Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium.Neurology. 2017; 89: 88-100
- Hospitalization in people with dementia with Lewy bodies: Frequency, duration, and cost implications.Alzheimers Dement (Amst). 2018; 10: 143-152
- Patients with Lewy body dementia use more resources than those with Alzheimer's disease.Int J Geriatr Psychiatry. 2007; 22: 713-719
- The impact of parkinsonism on costs of care in patients with AD and dementia with Lewy bodies.Neurology. 2003; 61: 944-949
- The use and costs of formal care in newly diagnosed dementia: A three-year prospective follow-up study.Am J Geriatr Psychiatry. 2014; 22: 381-388
- Comparison of costs of care between patients with Alzheimer's disease and dementia with Lewy bodies.Alzheimers Dement. 2008; 4: 280-284
- The costs of dementia subtypes to California Medicare fee-for-service, 2015.Alzheimers Dement. 2019; 15: 899-906
- The prognosis of dementia with Lewy bodies.Lancet Neurol. 2017; 16: 390-398
- Health research data for the real world: The MarketScan databases.Thomson Reuters, Toronto, Canada2008
- Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's.BMC Health Serv Res. 2008; 8: 108
- Implications of comorbidity on costs for patients with Alzheimer disease.Med Care. 2008; 46: 839-846
- Risk of antipsychotic drug use in patients with Alzheimer's disease treated with rivastigmine.Drugs Aging. 2004; 21: 395-403
- Patient adherence to transdermal rivastigmine after switching from oral donepezil: A retrospective claims database study.Alzheimer Dis Assoc Disord. 2013; 27: 182-186
- Assessing fluctuating cognition in dementia diagnosis: Interrater reliability of the clinician assessment of fluctuation.Am J Alzheimers Dis Other Demen. 2016; 31: 137-143
- Research criteria for the diagnosis of prodromal dementia with Lewy bodies.Neurology. 2020; 94: 743-755
- Treatment patterns and burden of behavioral disturbances in patients with dementia in the United States: A claims database analysis.BMC Neurol. 2019; 19: 33
- Cost-of-illness studies of dementia: A systematic review focusing on stage dependency of costs.Acta Psychiatr Scand. 2010; 121: 243-259
- The main cost drivers in dementia: A systematic review.Int J Geriatr Psychiatry. 2015; 30: 111-129
- Alzheimer's disease: The strength of association of costs with different measures of disease severity.J Nutr Health Aging. 2010; 14: 655-663
- Cognitive fluctuations in Lewy body dementia: Towards a pathophysiological framework.Brain. 2019; 143: 31-46
- Dementia with lewy bodies: Findings from an international multicentre study.Int J Geriatr Psychiatry. 2000; 15: 1034-1045
- Quantifying fluctuation in dementia with Lewy bodies, Alzheimer's disease, and vascular dementia.Neurology. 2000; 54: 1616-1625
- Diagnostic criteria for dementia with lewy bodies reconsidered.Am J Geriatr Psychiatry. 2001; 9: 212-216
- Fluctuating cognition in dementia with Lewy bodies and Alzheimer's disease is qualitatively distinct.J Neurol Neurosurg Psychiatry. 2004; 75: 382
- Delirium and dementia with Lewy bodies: Distinct diagnoses or part of the same spectrum?.J Neurol Neurosurg Psychiatry. 2015; 86: 50-59
- The incidence of recorded delirium episodes before and after dementia diagnosis: Differences between dementia with Lewy bodies and Alzheimer's disease.J Am Med Dir Assoc. 2019; 20: 604-609
- Revisiting DLB diagnosis: A consideration of prodromal DLB and of the diagnostic overlap with Alzheimer disease.J Geriatr Psychiatry Neurol. 2016; 29: 249-253
- Measuring diagnoses: ICD code accuracy.Health Serv Res. 2005; 40: 1620-1621
Article info
Publication history
Published online: August 06, 2020
Footnotes
This work was supported by Takeda Pharmaceuticals.
Robert Espinosa, Matthew Davis, and Scott Johnson are employees of Medicus Economics and received funding from Takeda Pharmaceuticals for this study. Stephanie Cline was employed by Takeda Pharmaceuticals when this study was conducted. Daniel Weintraub received funding from Takeda Pharmaceuticals to conduct this study.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
