Evidence suggests that enhancing support for caregivers of Alzheimer’s patients could yield significant benefits at a fraction of the costs associated with Alzheimer’s medications. A recent study, published on February 5, 2024, in *Alzheimer’s and Dementia: Behavior & Socioeconomics of Aging*, utilized computer simulations based on previous patient data. Researchers found that supportive care models not only reduced healthcare costs but also demonstrated a higher value compared to drug interventions.
As the number of dementia cases rises, the demand for effective care coordination has become increasingly pressing. Currently, an estimated 6.7 million Americans are living with Alzheimer’s and related forms of dementia. The introduction of disease-slowing drugs such as lecanemab has not alleviated the shortage of dementia specialists, leaving primary care physicians to manage these complex cases with limited resources.
To address these challenges, the University of California, San Francisco (UCSF) has implemented programs that connect caregivers with dedicated support resources. This initiative pairs caregivers with care navigators who provide ongoing assistance and information about dementia-related issues. These navigators, supported by a Medicare-covered program, maintain monthly communication with families, answering questions about medications, behavior management, and sleep issues.
Collaborative Care Models Offer Practical Solutions
According to Katherine Possin, a clinical psychologist at UCSF who directs the Care Ecosystem program, these collaborative care models transition families from crisis-oriented responses to more proactive support systems. “Families don’t know what to expect, transitioning to a calmer care environment where caregivers are supported,” she stated. The program has been adopted by over 50 health systems and community organizations across the United States.
In 2024, the U.S. Centers for Medicare & Medicaid Services began testing a new federal dementia care model, which compensates approved organizations for each enrolled Medicare patient. These collaborative care programs, alongside the approved Alzheimer’s therapies, show clear benefits based on prior research. However, according to Kelly Atkins, a clinical neuropsychologist at Monash University, it is impractical to directly compare these interventions across thousands of patients over extended periods.
Atkins and her colleagues employed a mathematical model to simulate a population of 1,000 individuals aged 71, mirroring participants from a significant trial involving lecanemab. The simulation presented three scenarios: 18 months of lecanemab treatment, collaborative care alone, or a combination of both. The model predicted the long-term outcomes of each intervention, influenced by national data on mortality rates, quality of life, and costs associated with varying stages of dementia.
The findings revealed that while lecanemab extended patients’ lives by an average of 0.17 years and delayed their entry into long-term care by the same duration, collaborative care provided an additional 0.34 years at home before requiring transition to a nursing facility. When combined, the drug treatment further postponed this transition by 0.16 years.
Cost Implications of Care Models
In terms of eligibility, approximately 1 million individuals with Alzheimer’s qualify for lecanemab, while over 6 million may benefit from collaborative dementia care. The annual cost of lecanemab is approximately $26,500, although actual expenses may fluctuate based on insurance coverage.
When the findings are scaled to the U.S. population, 18 months of collaborative care is projected to save $300 billion in healthcare costs, in stark contrast to the $39.5 billion expenditure associated with lecanemab. These estimates encompass total savings and dementia-related expenses, including additional medical procedures and nursing home care, if all eligible individuals received the respective interventions in 2024.
Dr. Josh Helman, a physician in Florida specializing in lifestyle measures for Alzheimer’s prevention and treatment, emphasized the long-term financial benefits of prioritizing care coordination. “Investing in dementia patient care can save healthcare dollars over time, reducing the need for costly memory care,” he asserted.
Despite these insights, some experts urge caution regarding the reliance on computer simulations for policy decisions. Dr. Daniel Press, a neurologist at Beth Israel Deaconess Medical Center in Boston, advocates for prospective data collection involving real patients to verify the benefits predicted by simulations.
As the healthcare landscape adapts to the complexities of delivering new Alzheimer’s treatments, the UCSF researchers aim to underscore the necessity for reform in dementia care. “Dementia care is not a lucrative area for health systems,” Possin noted, reflecting on the challenges of garnering attention from those involved in healthcare economics.
Improving support for caregivers not only represents a compassionate response to the needs of families affected by Alzheimer’s but also offers a pragmatic approach to managing healthcare costs in an increasingly strained system.
