Prevalence, costs, and treatment of Alzheimer's disease and related dementia: A managed care perspective

Background: The number of patients with Alzheimer's disease (AD) and relate d dementia treated in managed care organizations (MCOs) is increasing, and this trend is expected to continue. Therefore, it is critical that MCOs dev elop disease management strategies for this population. Objective: To review the literature on the prevalence, costs, and treatment of AD and related dementia. Study Design: Review of published articles from MEDLINE and peer-reviewed j ournals. Results: Prevalence of AD and related dementia is approximately 5.7% among those aged 65 and older. Prevalence data from claims-based studies of AD in managed care are lower, ranging from 0.55% to 0.83%. Costs for formal care average $27,672 per patient annually, with long-term care being the most c ostly component. Annual costs for informal care are estimated to be $10,400 to $34,517 per patient. Additional costs associated with AD include lost w ages and productivity of patients and caregivers and costs associated with increased morbidity of caregivers. Donepezil treatment is well tolerated an d has been extensively tested and evaluated in clinical settings. Early dia gnosis and treatment of AD with donepezil has been shown to slow cognitive decline in AD. Although study findings regarding the cost offsets of donepe zil-treated patients to date are mixed, there is a growing body of evidence to support the inclusion of this and other therapies into an MCO's AD trea tment armamentarium. Conclusions: It is unlikely that MCOs will escape the increased prevalence and costs associated with AD. Opportunities exist through patient managemen t programs targeted toward early diagnosis, effective use of medications, c ontrol of comorbidities, and patient and family support to partially offset these costs while providing quality patient care.