Alzheimer’s disease may cost the United States alone more than $1.3 trillion by 2050, but early diagnosis could be one way to mitigate at least some of that increase, a special report released by the Alzheimer’s Association says.
An improved clinical scenario, with 88% of patients diagnosed in the early stage of mild cognitive impairment (MCI), could save $231.4 billion in direct treatment and long-term care costs by that time, according to the report, contained in the 2018 Alzheimer’s Disease Facts and Figures. Extrapolated out to the full lifespan of everyone now alive in the United States, the 88% diagnostic scenario could reap $7 trillion in savings, the report noted. This benefit would comprise $3.3 trillion in Medicare savings, $2.3 trillion in Medicaid savings, and $1.4 trillion in other areas of spending, including out-of-pocket expenses and private insurance.
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The improved clinical diagnosis picture could manifest if diagnoses were based solely on biomarkers rather than the current method, which relies largely on symptoms and performance on cognitive tests, without biomarker confirmation. The biomarker-based diagnostic algorithm has been proposed for research cohorts, but not for clinical care.
The diagnostic workup currently employed, which is most often not confirmed with biomarkers, “means that many people who are diagnosed with Alzheimer’s may in reality have MCI or dementia due to other causes,” the report noted. Studies consistently show that up to 30% of patients diagnosed with apparent Alzheimer’s actually have another source of cognitive dysfunction. The misdiagnosis gap haunts clinical trialists and makes a strong case for incorporating biomarkers, including amyloid imaging, into the diagnostic workup – something the Alzheimer’s Association is pushing for with its IDEAS study.
Diagnostic reliance on symptoms and cognitive test performance without the additional information provided by biomarkers can affect the confidence clinicians have in making a diagnosis and thereby delay a diagnosis, dementia specialist Marwan N. Sabbagh, MD, said when asked to comment on the report.
“The report by the Alzheimer’s Association underscores the fact that early diagnosis of dementia or MCI due to Alzheimer’s disease is important not only because it is good health care but because net savings can be realized. The simple fact is that physicians have been taught to approach a diagnosis of dementia as a diagnosis of exclusion and they have been told that a diagnosis can be absolutely attained only by biopsy or autopsy. The consequence of these messages is that there is a lack of confidence in the clinic diagnosis and a subsequent delay in making a diagnosis,” said Dr. Sabbagh, the Karsten Solheim Chair for Dementia, professor of neurology, and director of the Alzheimer’s and memory disorders division at the Barrow Neurological Institute, Phoenix. “The deployment of in vivo biomarkers will transform the diagnosis from one of exclusion to one of inclusion. The up front costs will be saved later in the course.”