Dementia drugs often prescribed longer than evidence supports

Elizabeth A. Carter

A report by the AARP Public Policy Institute found that 70% of elderly patients with dementia prescribed dementia medications took them long-term despite a shortage of clinical evidence supporting their benefit beyond 1 year.

Furthermore, the study reported that some patients took dementia medication for up to a decade, costing as much as $18,000 per patient.

“The prevalence of dementia is expected to rise to 14 million people by 2050. While some prescription drugs are available to help treat the disease, it doesn’t seem to be widely known that such treatments have limited efficacy,” Elizabeth A. Carter, PhD, MPH, OptumLabs visiting fellow at the AARP Public Policy Institute, told Healio Psychiatry. "Given that long-term use of dementia drugs could have financial and health implications for patients, we wanted to examine real-world prescribing patterns."

Considering the limited efficacy, possible adverse effects and cost associated with the two types of FDA-approved drugs for treating dementia symptoms — cholinesterase inhibitors and memantine — Carter and Leigh Purvis, MPA, director of health services research at AARP Public Policy Institute, examined the duration and costs of treatment with these medications.

The researchers conducted a retrospective analysis of de-identified claims obtained by OptumLabs Data Warehouse from more 70,987 Medicare Advantage enrollees aged 65 years or older with a new dementia diagnosis between 2006 and 2015. They classified patients with dementia into one of four drug groups: no drugs, cholinesterase inhibitors only, memantine only and a combination of the two medications. They then calculated allowable costs (combined amounts paid by patients and insurers) from each claim on the date of dementia drug prescription fill.

Overall, 50.7% of the study sample were prescribed a dementia drug within 1 year of their diagnosis and 70% of older adults with dementia were prescribed dementia drugs for 13 months or longer. Carter and Purvis found that 11% received treatment with dementia drugs for 1 month or less, and 19% were treated for between 2 months and 12 months.

Of the 36,000 enrollees in the sample who initiated medication treatment for dementia, 58% were prescribed cholinesterase inhibitors, 33% were prescribed cholinesterase inhibitors and memantine and 8% were prescribed memantine only. In addition, 16% were prescribed cholinesterase inhibitors or memantine without an accompanying diagnosis of dementia on the insurance claim.

The results showed that patients taking cholinesterase inhibitors and memantine together had the highest total dementia drug costs, with an average of $151 per month (up to $1,050) and more than $4,800 (up to $19,316) over the 10-year study period. Alone, the costs for memantine averaged $200 per month and $3,163 over the study period, but the costs were much lower for cholinesterase inhibitors, averaging $59 per month and $997 total.

Up to $18,000 of total dementia drug spending occurred after the first year of use, which is beyond the duration of treatment supported by evidence, according to the researchers.

“It’s important to regularly re-assess patients’ prescription drug regimens to help ensure that they remain appropriate as new drugs are added and/or health needs change,” Carter told Healio Psychiatry.

“Older adults typically take multiple medications, often on a long-term basis, and see multiple health care providers without any meaningful oversight of their overall prescription drug regimens,” Purvis said in a press release. “These findings really highlight the importance of ensuring that health care providers have access to reliable information to help them reassess medications that may no longer be of benefit, or even cause harm.” – by Savannah Demko

Reference:

Carter EA, Purvis L. “Reducing Potential Overuse of Dementia Drugs Could Lead to Considerable Savings.” www.aarp.org/dementiadrugstudy. Accessed on Aug. 21, 2018.

Disclosures: Carter and Purvis are from the AARP Public Policy Institute.