- Email: [email protected]
LEVERAGING MEDICARE CLAIMS TO CHARACTERIZE DIAGNOSTIC PATHWAYS IN ALZHEIMER’S DISEASE
Podium Presentations: Thursday, July 20, 2017 O5-03-03
LEVERAGING MEDICARE CLAIMS TO CHARACTERIZE DIAGNOSTIC PATHWAYS IN ALZHEIMER’S DISEASE
Rezaul Karim Khandker, Vinay Mehta, Christopher M. Black, Tiffini Voss, Brady Dubin, Baishali M. Ambegaonkar, Mark Marsico, Merck & Co., Inc., Kenilworth, NJ, USA. Contact e-mail: [email protected] Background: Real-world, administrative claims data is uniquely suited to help characterize the journey of Alzheimer’s disease (AD) patients from the onset of disease symptoms through diagnosis and beyond. The primary aims of this analysis were to: (1) characterize the temporal relationship between diagnostic and treatment codes associated with AD; and (2) explore the pre-diagnostic claims record for the appearance of codes suggestive of ADrelated symptoms. Methods: Medical and pharmacy claims data from a large, geographically diverse, commercial, US Medicare Advantage health plan, for the period 2009-2014, was used to identify cases of newly diagnosed AD. Beneficiaries with claims for AD-specific diagnostic codes and prescription fills for a medication indicated to treat AD were included in the analysis. Results: Among the 4,039 beneficiaries identified for inclusion in the analysis: 31% received a treatment prior to their first Alzheimer’s-specific diagnostic code, 14% received an AD diagnostic code prior to their first treatment; and 23% received their treatment and diagnostic codes within 60 days of one another. Thirty-percent of the diagnosed cohort had multiple diagnostic codes but no evidence of treatment at any time during the 48-month observation period (24 months prior to and after incident diagnosis). Notable gaps between treatment and diagnosis were observed. The median number of days between treatment and diagnosis among those receiving a treatment first was 577; the median number of days between diagnosis and treatment in those receiving a diagnosis first was 397. Sixty-three percent of the combined cohort had an average of 6.1 claims suggestive of AD-related symptoms (e.g. memory loss, mild cognitive impairment) before their incident diagnostic code. Conclusions: These data suggests there is considerable heterogeneity in the AD diagnostic and treatment pathways. While the first appearance of a diagnosis code is commonly used as the index date from which disease related health care use is attributed, measurable careseeking behavior and therapy associated with AD begins much earlier. Further research is needed to better understand the factors influencing pathway variability and the risks associated with diagnostic and treatment delays.
P1459
vices to remain at home and maintain optimal quality of life. Capacity planning for dementia-related health services is important to to understand the current needs of persons with dementia and plan for their future needs. Our project developed a Dementia Capacity Planning model for the province of Ontario in Canada to understand the current and future numbers of individuals with dementia in Ontario and anticipate their health service utilization. Methods: A validated diagnostic algorithm was used with provincial administrative health care databases to identify the historical number of community-dwelling individuals with dementia in Ontario between 2010 – 2015. The historical patterns of health service utilization including home care services, and applications for longterm care (LTC) admissions were then determined. Agent based simulation models were then used to simulate future numbers of community dwelling individuals with dementia in Ontario as well their future health service utilization based on demographic trends and current health system resources. Results: The number of community-dwelling individuals with dementia increased from 81,637 individuals in 2010 to 106,427 individuals in 2015 (+30%). Using conservative estimates, the simulation model projected that this number will increase to 143,557 by 2020 (+35% over 2015). The total number of individuals with dementia in the community who have requested admission to LTC and were awaiting placement increased from 12,866 in 2010, to 22,063 in 2015 (+71%) and this number is projected to increase to 39,789 individuals by 2020 (+80% over 2015). The annual number of personal support worker hours provided by home care services is projected to be over 11 million hours by 2020, an increase of 50% over 2015 utilization. Conclusions: The growing population of older adults with dementia in Ontario will result in significant increased demands for home care and LTC services. Simulation models can be useful to understand these future demands and help in planning services accordingly. Significant changes to health services and supports for persons with dementia will likely be required to support this growing and vulnerable population in Ontario in the future.
O5-03-05
MONITORING PROGRESS IN THE GLOBAL PUBLIC HEALTH RESPONSE TO THE DEMENTIA CRISIS
Emiliano Albanese, WHO Collaborating Center, Geneva, Switzerland; University of Geneva, Geneva, Switzerland. Contact e-mail: [email protected] O5-03-04
CAPACITY PLANNING FOR COMMUNITYBASED DEMENTIA HEALTH CARE SERVICES IN ONTARIO, CANADA, USING ADMINISTRATIVE HEALTH CARE DATABASES AND AGENT-BASED SIMULATION METHODS
Dallas Seitz1,2,3, Tannaz Mahootchi1, Danielle Shawcross1, Kerry Allerton1, Natalie Warrick1, Alivahit Esensoy1, 1Cancer Care Ontario, Toronto, ON, Canada; 2Queen’s University, Kingston, ON, Canada; 3Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, ON, Canada. Contact e-mail: [email protected] Background: Most individuals with dementia reside in community settings and this population requires a variety of supports and ser-
Background: The enormous burden posed by dementia on individ-
uals and societies worldwide is expected to dramatically increase in the coming years. A comprehensive public health approach has been called for by WHO in 2012. More than 90 UN Member States are now involved in an unprecedented global response, which relies on the widely accepted stance that major advances in our understanding of dementia, its prevention, diagnosis, treatment and care, and a significant reduction of its burden (including costs) can be achieved only through a concerted global effort Methods: A Global Dementia Observatory (GDO) was developed by WHO in 2016, with assistance from the Geneva and other WHO collaborating centers (WHO CC). This surveillance platform was designed to collect data at the governance, population, and individual level to
LEVERAGING MEDICARE CLAIMS TO CHARACTERIZE DIAGNOSTIC PATHWAYS IN ALZHEIMER’S DISEASE
Rezaul Karim Khandker, Vinay Mehta, Christopher M. Black, Tiffini Voss, Brady Dubin, Baishali M. Ambegaonkar, Mark Marsico, Merck & Co., Inc., Kenilworth, NJ, USA. Contact e-mail: [email protected] Background: Real-world, administrative claims data is uniquely suited to help characterize the journey of Alzheimer’s disease (AD) patients from the onset of disease symptoms through diagnosis and beyond. The primary aims of this analysis were to: (1) characterize the temporal relationship between diagnostic and treatment codes associated with AD; and (2) explore the pre-diagnostic claims record for the appearance of codes suggestive of ADrelated symptoms. Methods: Medical and pharmacy claims data from a large, geographically diverse, commercial, US Medicare Advantage health plan, for the period 2009-2014, was used to identify cases of newly diagnosed AD. Beneficiaries with claims for AD-specific diagnostic codes and prescription fills for a medication indicated to treat AD were included in the analysis. Results: Among the 4,039 beneficiaries identified for inclusion in the analysis: 31% received a treatment prior to their first Alzheimer’s-specific diagnostic code, 14% received an AD diagnostic code prior to their first treatment; and 23% received their treatment and diagnostic codes within 60 days of one another. Thirty-percent of the diagnosed cohort had multiple diagnostic codes but no evidence of treatment at any time during the 48-month observation period (24 months prior to and after incident diagnosis). Notable gaps between treatment and diagnosis were observed. The median number of days between treatment and diagnosis among those receiving a treatment first was 577; the median number of days between diagnosis and treatment in those receiving a diagnosis first was 397. Sixty-three percent of the combined cohort had an average of 6.1 claims suggestive of AD-related symptoms (e.g. memory loss, mild cognitive impairment) before their incident diagnostic code. Conclusions: These data suggests there is considerable heterogeneity in the AD diagnostic and treatment pathways. While the first appearance of a diagnosis code is commonly used as the index date from which disease related health care use is attributed, measurable careseeking behavior and therapy associated with AD begins much earlier. Further research is needed to better understand the factors influencing pathway variability and the risks associated with diagnostic and treatment delays.
P1459
vices to remain at home and maintain optimal quality of life. Capacity planning for dementia-related health services is important to to understand the current needs of persons with dementia and plan for their future needs. Our project developed a Dementia Capacity Planning model for the province of Ontario in Canada to understand the current and future numbers of individuals with dementia in Ontario and anticipate their health service utilization. Methods: A validated diagnostic algorithm was used with provincial administrative health care databases to identify the historical number of community-dwelling individuals with dementia in Ontario between 2010 – 2015. The historical patterns of health service utilization including home care services, and applications for longterm care (LTC) admissions were then determined. Agent based simulation models were then used to simulate future numbers of community dwelling individuals with dementia in Ontario as well their future health service utilization based on demographic trends and current health system resources. Results: The number of community-dwelling individuals with dementia increased from 81,637 individuals in 2010 to 106,427 individuals in 2015 (+30%). Using conservative estimates, the simulation model projected that this number will increase to 143,557 by 2020 (+35% over 2015). The total number of individuals with dementia in the community who have requested admission to LTC and were awaiting placement increased from 12,866 in 2010, to 22,063 in 2015 (+71%) and this number is projected to increase to 39,789 individuals by 2020 (+80% over 2015). The annual number of personal support worker hours provided by home care services is projected to be over 11 million hours by 2020, an increase of 50% over 2015 utilization. Conclusions: The growing population of older adults with dementia in Ontario will result in significant increased demands for home care and LTC services. Simulation models can be useful to understand these future demands and help in planning services accordingly. Significant changes to health services and supports for persons with dementia will likely be required to support this growing and vulnerable population in Ontario in the future.
O5-03-05
MONITORING PROGRESS IN THE GLOBAL PUBLIC HEALTH RESPONSE TO THE DEMENTIA CRISIS
Emiliano Albanese, WHO Collaborating Center, Geneva, Switzerland; University of Geneva, Geneva, Switzerland. Contact e-mail: [email protected] O5-03-04
CAPACITY PLANNING FOR COMMUNITYBASED DEMENTIA HEALTH CARE SERVICES IN ONTARIO, CANADA, USING ADMINISTRATIVE HEALTH CARE DATABASES AND AGENT-BASED SIMULATION METHODS
Dallas Seitz1,2,3, Tannaz Mahootchi1, Danielle Shawcross1, Kerry Allerton1, Natalie Warrick1, Alivahit Esensoy1, 1Cancer Care Ontario, Toronto, ON, Canada; 2Queen’s University, Kingston, ON, Canada; 3Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, ON, Canada. Contact e-mail: [email protected] Background: Most individuals with dementia reside in community settings and this population requires a variety of supports and ser-
Background: The enormous burden posed by dementia on individ-
uals and societies worldwide is expected to dramatically increase in the coming years. A comprehensive public health approach has been called for by WHO in 2012. More than 90 UN Member States are now involved in an unprecedented global response, which relies on the widely accepted stance that major advances in our understanding of dementia, its prevention, diagnosis, treatment and care, and a significant reduction of its burden (including costs) can be achieved only through a concerted global effort Methods: A Global Dementia Observatory (GDO) was developed by WHO in 2016, with assistance from the Geneva and other WHO collaborating centers (WHO CC). This surveillance platform was designed to collect data at the governance, population, and individual level to