Published: Jul 17, 2013 | Updated: Jul 19, 2013
By John Gever, Deputy Managing Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
Action Points
· Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.
· When patients with vascular or Parkinson's disease-related dementias are initially misdiagnosed as having Alzheimer's disease, their cost of care rises dramatically.
· Point out that there are technologies now available to help reach a more accurate diagnosis of Alzheimer's disease, such as beta-amyloid tracers for PET imaging sold by Eli Lilly, which sponsored the study.
BOSTON -- When patients with vascular or Parkinson's disease-related dementias are initially misdiagnosed as having Alzheimer's disease, their cost of care rises dramatically, a researcher said here.
In an analysis of anonymous Medicare beneficiary records, about one in six individuals receiving diagnoses of vascular dementia had previously been diagnosed with Alzheimer's disease, incurring average Medicare claims of about $12,000 to $14,000 during the year of diagnosis change over and above the costs recorded for individuals with unchanged vascular dementia diagnoses, said Noam Kirson, PhD, of Analysis Group based here.
Similarly, about one-twelfth of beneficiaries with records indicating a Parkinson's disease diagnosis also had an earlier diagnosis of Alzheimer's disease, with average extra costs during the year of "correct" diagnosis ranging from about $9,500 to more than $14,000, Kirson told attendees at the Alzheimer's Association International Conference.
"Diagnosing Alzheimer's disease correctly can be quite challenging in clinical practice," he said at a press briefing prior to his formal presentation. 'There is a lot of overlap in the presentation of clinical symptoms between Alzheimer's disease and other dementias."
With technologies now available to help reach a more accurate diagnosis of Alzheimer's disease -- such as beta-amyloid tracers for PET imaging sold by Eli Lilly, which sponsored Kirson's study -- the costs of misdiagnosis may increasingly be seen as avoidable and therefore worthy of evaluation, he suggested.
He and colleagues (including economics researchers from Lilly) obtained a data set on a randomly selected 5% of Medicare beneficiaries with diagnoses of vascular dementia or Parkinson's disease. The researchers then looked for those who had received diagnoses of Alzheimer's disease from 1 to 3 years previously, comparing their yearly Medicare claims with those of other vascular dementia or Parkinson's disease patients whose records did not indicate an earlier Alzheimer's disease claim over the same period.
Totals of 2,544 beneficiaries with vascular dementia and 2,604 with Parkinson's disease had been misdiagnosed earlier, the researchers determined.
For both types of patients, Kirson said, Medicare claims spiked in the year in which those with an Alzheimer's disease diagnosis then received one for vascular dementia or Parkinson's disease.
The increases in claims, when compared with control beneficiaries with no change in diagnosis were as follows:
· Vascular dementia: year 1, $11,967; year 2, $14,101; year 3, $12,936
· Parkinson's disease: year 1, $9,526; year 2, $12,011; year 3, $14,241
In both groups, Kirson noted, patients whose diagnoses were changed in year 3 also had markedly higher claims costs the year earlier -- $7,382 for those later diagnosed with vascular dementia and $11,073 in those later diagnosed with Parkinson's disease.
But following the switch in diagnoses, costs in all patients in both groups quickly declined to the levels seen in beneficiaries with unchanged diagnoses. In study year 4, at which point all patients in the analysis had carried their final diagnosis for at least 1 year, there was no significant difference in claims.
William Thies, MD, senior scientist in residence at the Alzheimer's Association, asked during the briefing if these data could be used to derive a cost-effectiveness threshold for brain amyloid scans. His mental arithmetic on the spot produced an estimate of $1,900, on the basis of Kirson's data.
Kirson said it was "tempting" but much more research is needed before the cost-effectiveness of such scans can be determined for routine practice.
"It's not only about how many people have these conditions, but also the likelihood that we can prevent the misdiagnosis with the scan that may not be perfect. We need to do more work to find out how much of the misdiagnosis is preventable," he said.
Briefing moderator Ralph Nixon, MD, of New York University in New York City, said the study was important in at least two ways.
"When you make an incorrect diagnosis of Alzheimer's disease in someone who has a different disease, it has a number of implications -- among them being the increase in medical costs, but also, as importantly or more importantly, the deprivation of the opportunity to get the proper treatment for that misdiagnosed condition."
The study was funded by Eli Lilly. Several investigators were Lilly employees.
Kirson had no other disclosures.
Nixon had a relationship with Takeda.
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