Research indicates that enhancing support for caregivers of Alzheimer’s patients may yield significant health benefits at a fraction of the cost of traditional drug interventions. A study published on February 5 in the journal Alzheimer’s and Dementia: Behavior & Socioeconomics of Aging utilized a computer simulation informed by previous patient data. The findings suggest that supportive care not only reduces healthcare costs but also outperformed drug treatments on a standard measure of treatment value.
The growing incidence of dementia, which currently affects an estimated 6.7 million Americans, has intensified the need for effective care strategies. Despite the recent arrival of disease-slowing Alzheimer’s drugs, specialists in dementia care remain scarce. Consequently, the burden of managing these complex cases often falls on primary care physicians who are already stretched thin in terms of time and resources.
To improve care coordination, researchers at the University of California, San Francisco (UCSF) have developed a program that connects caregivers with experienced individuals who can provide relevant support and information. This initiative, known as the Care Ecosystem, has been operating for over a decade and is covered by Medicare. Care navigators involved in the program reach out to families monthly, addressing questions related to medications, behavioral issues, and overall care. They also facilitate connections with specialists including clinicians, nurses, pharmacists, and social workers.
Katherine Possin, a clinical psychologist at UCSF and director of the Care Ecosystem program, explains that these collaborative care models shift the approach from reactive, crisis-oriented care to proactive support for caregivers. This transition fosters a calmer environment for families, allowing them to better assist their loved ones with dementia.
Similar initiatives are underway at institutions like UCLA. In 2024, the U.S. Centers for Medicare & Medicaid Services initiated a trial of a federal dementia care model, reimbursing approved organizations for each enrolled Medicare patient.
The advantages of these collaborative care programs compared to approved Alzheimer’s therapies are underscored by prior research. Nevertheless, directly comparing the two interventions over extensive patient cohorts and timeframes poses impractical challenges, according to Kelly Atkins, a clinical neuropsychologist at Monash University in Melbourne, Australia. Atkins, who was a former postdoctoral researcher at UCSF, and her team employed a mathematical model simulating a population of 1,000 individuals aged 71. The demographic characteristics of this group mirrored those of participants in a significant clinical trial of the Alzheimer’s drug lecanemab (marketed as Leqembi).
In their model, subjects faced one of three scenarios: receiving 18 months of lecanemab, engaging in collaborative care, or combining both interventions. The model’s predictions were informed by national mortality rates, quality of life data, and the costs associated with varying stages of dementia.
The findings revealed that relative to conventional care, lecanemab extended patients’ lives by 0.17 years and delayed their transition into long-term care by the same duration. In contrast, while collaborative care did not extend life expectancy, it offered patients an additional 0.34 years at home before moving into nursing facilities. Notably, combining the drug with collaborative care delayed the transition by an additional 0.16 years.
The implications of these findings are substantial. Approximately 1 million people in the U.S. could qualify for lecanemab based on their disease stage, while over 6 million individuals would be eligible for collaborative dementia care. The annual cost of lecanemab is estimated at $26,500, but actual patient expenses will vary depending on insurance coverage and other factors. When scaled to the U.S. population, the analysis indicates that 18 months of collaborative care could save around $300 billion in healthcare costs, while lecanemab would incur a total cost of $39.5 billion. These figures encompass total savings and dementia-related costs, including additional medical procedures and nursing home care, should all eligible individuals receive the interventions in 2024.
Josh Helman, a physician based in South Florida who specializes in lifestyle interventions for Alzheimer’s prevention and treatment, emphasizes the long-term financial benefits of investing in coordinated care for dementia patients. He asserts that this approach can lead to significant healthcare savings, contrasting sharply with the potential costs of managing side effects or requiring expensive memory care later on.
Yet, experts caution against relying solely on computer simulations. Daniel Press, a neurologist at Beth Israel Deaconess Medical Center in Boston, insists that data collected from real patient experiences should be gathered prospectively to determine whether these models translate into tangible benefits for patients and their families.
As healthcare systems grapple with the complexities of administering newly approved Alzheimer’s therapies, the UCSF researchers hope their study highlights the urgent need for reform in dementia care. Katherine Possin remarks, “Let’s face it, dementia care is not where the health system is making a lot of money. It’s hard to get the business folks in medicine to pay attention to making changes and improvements.”
