Early Alzheimer's diagnosis offers large social, fiscal benefits

Patients with Alzheimer's disease and other dementias are heavy users of long-term care services, especially nursing home care, with estimated annual costs upward of tens of billions of dollars nationwide.

Much of the fiscal burden is borne by state and federal governments — and thus taxpayers — through the Medicaid and Medicare programs. For example, the Wisconsin Medicaid program spends almost half a billion dollars each year on nursing home care for just 11,000 dementia patients — a tiny fraction of the estimated 160,000 affected people in the state, says Mark Sager, director of the Wisconsin Alzheimer's Institute of the UW-Madison School of Medicine and Public Health.

These costs could be greatly reduced by earlier diagnosis and treatment, he says in a new study co-authored by La Follette School of Public Affairs professor David Weimer. The research, a cost-benefit analysis of the social and fiscal impacts of early identification and treatment of Alzheimer's disease, using Wisconsin as a model, appears in the May issue of Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

“The future of this disease is to intervene decades before someone becomes symptomatic. This analysis says you can save literally billions of dollars in long-term care costs if you can intervene at an earlier stage,” Sager says. “What you don't know costs a lot of money when it comes to this disease.”

The issue is becoming more pressing as the population ages, with some estimates placing the incidence of Alzheimer's disease in the U.S. around 1 million cases by 2050, the authors say.

“We need to begin now to make the public-policy changes that will allow and encourage early recognition and intervention,” says Sager. “This article says to all the legislators facing deficits, 'here's a way to save money, and you can do it by providing better care.' It's a win for legislators, it's a win for patients, it's a win for families.”

The analysis considers two types of interventions following diagnosis: patient drug treatment and caregiver-support programs. Each would provide positive net savings, with the greatest benefits achieved using a combination of both.

“Even just with currently available drug treatments, [early diagnosis] seems to offer positive social benefits. If we had a stronger caregiver-support network, it could be even greater,” Weimer says.

They predict even larger benefits if more effective drug treatments are developed and if public policy supported caregiver benefits, such as counseling and support groups.

Currently, Medicare does not support caregiver-intervention programs. Even accounting for implementation costs, the new analysis suggests that they would result in net savings to governments by reducing the care burden on medical systems.

“It does take some investment early on, and of course this is a time when all state dollars are tight. But from the long-run perspective, it looks like it's a clear winner,” says Weimer.

In addition to substantial financial savings — on average $10,000 net savings to the state alone per patient diagnosed in Wisconsin — their analysis showed that early identification and intervention would lead to positive social outcomes, including slower disease progression and improved quality of life for the patients' families and caregivers. These combined social benefits would total around $100,000 for the typical patient, Weimer says, and could climb to five times that with the development of drugs that could stop disease progression.

A major challenge to reaping these potential savings is the current lack of mechanisms for screening and early diagnosis, allowing the vast majority of affected people to go unrecognized, Sager says. “We will have to develop systems of cognitive screening if we are going to eventually identify people at early stages when future medications and caregiver interventions are most likely to be helpful.”

“There are many physical, emotional and social benefits of early detection, diagnosis and intervention for people with Alzheimer's and their caregivers,” says Shelley Morrison Bluethmann, director of early stage initiatives at the Alzheimer's Association, a health advocacy organization. “Early detection empowers people with the disease to participate in decisions about their treatment and future care, as well as consider clinical trial opportunities. Being diagnosed early is vital to receiving the best help and care possible.”

The work was partially supported by the Institute for Clinical and Translational Research at UW-Madison.

— Jill Sakai, jasakai@wisc.edu, 608-262-9772