Programs that support caregivers of dementia patients could provide substantial benefits at a fraction of the cost of an Alzheimer’s drug.
A computer simulation guided by patient data from previous studies found that supportive care reduced health care costs and achieved superior results compared to drug intervention on a common measure of treatment value, researchers report February 5 in Alzheimer’s and dementia: behavior and socio-economics of aging. Although not based on direct patient observations, the findings highlight the impact of improving care coordination. cases of dementia are increasing.
Drugs that slow Alzheimer’s disease entered the market in recent years. But dementia specialists are in short supply, leaving care for the 6.7 million Americans living with Alzheimer’s and other forms of dementia largely to primary care doctors, strapped for time and resources.
To help families navigate this fragmented health care system, researchers at the University of California, San Francisco, are pairing caregivers with people who provide dementia-related support and information. Through a decade-old Medicare-covered program, these care navigators call families monthly and answer questions related to medications, sleep or behavior, as needed. They also connect caregivers with specialists, including clinicians, nurses, pharmacists and social workers.
These collaborative care models “move from crisis-focused care, where families don’t know what to expect, to more proactive, calm care, where the caregiver is supported to help their loved one,” says Katherine Possin, a clinical psychologist at UCSF. She leads the Care Ecosystem program which is used by more than 50 health systems and community organizations across the United States. UCLA has a similar program, and in 2024 the U.S. Centers for Medicare & Medicaid Services began testing a federal program. dementia care modelpaying approved organizations for each patient enrolled in Medicare.
The benefits of collaborative care programs and approved Alzheimer’s therapies are clear from previous research. But it would be impractical and costly to directly compare these interventions in thousands of patients over several decades, says Kelly Atkins, a former UCSF postdoctoral fellow who now works as a clinical neuropsychologist at Monash University in Melbourne, Australia.
Instead, Atkins and colleagues used a mathematical model with a simulated population of 1,000 71-year-olds. Their average age and characteristics reflected participants from a large published essay of the Alzheimer’s disease drug lecanemab (brand name Leqembi). Subjects were presented with one of three scenarios: 18 months of lecanemab, collaborative care, or both. Similar to climate models that estimate how different courses of action might affect the planet over time, the computer model predicted the outcomes of each intervention across patients’ lives, informed by national data on mortality rates, quality of life and costs associated with mild to severe dementia.
Compared to usual care, lecanemab prolonged patients’ lives by 0.17 years and delayed their entry into long-term care by 0.17 years. In comparison, collaborative programs did not extend lives but gave patients 0.34 additional years at home before moving to a nursing home. Adding the drug further delayed this transition by 0.16 years.
In the United States, about 1 million people with Alzheimer’s disease would be eligible for lecanemab depending on disease stage and other factors, while more than 6 million people with dementia would be eligible for dementia care, the authors estimate. The drug costs $26,500 per year, although patients’ actual costs vary depending on insurance coverage and other factors.
Thus, across the US population, compared to usual care, 18 months of collaborative care saved $300 billion in health care costs, while lecanemab cost $39.5 billion. These figures estimate the total savings and costs associated with dementia – including additional medical procedures and nursing home care – over the remaining lifespan, if everyone eligible in 2024 received the interventions, Atkins says.
“It makes perfect sense,” says Josh Helman, a South Florida doctor who focuses on diet, exercise and lifestyle measures to prevent and treat Alzheimer’s disease. Dedicating resources to coordinating care for dementia patients can save money in the long term “instead of waiting for side effects later or having to pay for expensive memory care,” says Helman, who was not involved in the study.
Other experts warn against extrapolating from computer simulations. Data from real people needs to be collected prospectively – from a specific point in time – “to determine whether this model results in benefits for patients and their families,” says Daniel Press, a neurologist at Beth Israel Deaconess Medical Center in Boston.
As health systems grapple with the complexities of providing new Alzheimer’s drugs, UCSF researchers hope their study shows the importance of dementia care reform. “Let’s be real, dementia [care] “This is not the area where the health system makes a lot of money,” Possin says. “It’s difficult to get business people in medicine to pay attention to changes and improvements.”
