Programs that match caregivers with patient navigators yield better outcomes than\u00a0Alzheimer’s drug \u2013 but combining the two may be best.\u00a0<\/p>\n
A Medicare-covered program that offers support and medical advice for caregivers of patients with dementia may bring more benefit than a costly Alzheimer’s medication, new research finds.\u00a0<\/p>\n
UC San Francisco researchers compared outcomes for patients in collaborative care programs with those taking\u00a0lecanemab, one of two approved drugs that have been shown to slow progression of Alzheimer’s in some patients.\u00a0<\/p>\n
UCSF Health was an early leader in developing a collaborative care program with the\u00a0Care Ecosytem, which supports patients and caregivers. Paid navigators coordinate with clinical teams and connect caregivers to community resources.\u00a0The program has informed similar efforts and has been adopted and adapted by more than 50 health systems nationwide.\u00a0<\/p>\n
Collaborative care\u00a0improved quality of life, reduced costs, alleviated caregiver burden, and extended the time that patients\u00a0remained\u00a0in the community before entering a nursing facility, as compared to\u00a0lecanemab. Results were published\u00a0Feb. 5 in\u00a0Alzheimer’s and Dementia: Behavior and Socioeconomics of Aging.\u00a0<\/p>\n
The researchers created a simulated cohort of 1,000 patients using data from\u00a0previous\u00a0studies. About half had mild Alzheimer’s and half had mild cognitive impairment (MCI), which precedes it. Replacing usual care with collaborative care gave patients an extra 0.26 quality-adjusted life years (QALYs), a measure that reflects living longer in better health. When\u00a0lecanemab\u00a0was added to collaborative care, patients gained another 0.16 QALYs.\u00a0<\/p>\n
Collaborative care can serve a broader population\u00a0than medication,\u00a0said\u00a0first author Kelly J. Atkins,\u00a0DPsych, formerly of the\u00a0UCSF Fein Memory and Aging Center.\u00a0<\/p>\n
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Lecanemab\u00a0is only indicated for patients with mild Alzheimer’s and MCI, but collaborative programs can be used for more advanced disease, as well as for the 20% to 40% of patients with other types of dementia. The drug may also be out of reach for rural residents living far from specialty clinics, and for low-income patients struggling to manage out-of-pocket costs.”\u00a0<\/p>\n
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Kelly J. Atkins,\u00a0DPsych<\/p>\n
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The researchers found adding\u00a0lecanemab\u00a0to treatment increased health care costs by $38,400, but this was offset by adding collaborative care. The latter saved $48,000 per patient, partially due to fewer hospital visits. Patients also had, on average, four more months at home before transitioning to a nursing home when they received collaborative care.\u00a0<\/p>\n
“We’re\u00a0going to see more drugs and better drugs soon, and I think\u00a0that’s\u00a0very exciting. But we\u00a0can’tjust focus on the drugs, we need to rethink our system of care,” said Professor\u00a0Katherine L. Possin, PhD, of the UCSF Department of Neurology and the Fein Memory and Aging Center. “Clinics that integrate collaborative care with the drugs may be best positioned to meet the needs of patients in this new treatment era.”\u00a0<\/p>\n
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