Programs matching caregivers with patient navigators yield better results than Alzheimer’s drug – but a combination of the two may be best.
A Medicare-covered program that offers support and medical advice to caregivers of dementia patients may provide more benefits than a costly Alzheimer’s drug, new research suggests.
UC San Francisco researchers compared outcomes for patients in collaborative care programs with those receiving lecanemab, one of two approved drugs that have been shown to slow the progression of Alzheimer’s disease in some patients.
UCSF Health has pioneered the development of a collaborative care program with the Care Ecosytem, which supports patients and caregivers. Paid navigators coordinate with clinical teams and connect caregivers to community resources. The program has informed similar efforts and has been adopted and adapted by more than 50 health systems nationwide.
Collaborative care improved quality of life, reduced costs, reduced caregiver burden, and extended the time patients stayed in the community before admission to a nursing facility, compared with lecanemab. The results were published on February 5 at Alzheimer’s and dementia: Behavior and socioeconomics of aging.
The researchers created a simulated cohort of 1,000 patients using data from previous studies. About half had mild Alzheimer’s disease and half had mild cognitive impairment (MCI), which precedes it. Replacing usual care with collaborative care gave patients an additional 0.26 quality-adjusted life years (QALYs), a measure that reflects longer life expectancy in better health. When lecanemab was added to collaborative care, patients gained an additional 0.16 QALYs.
Collaborative care may serve a broader population than medication, said first author Kelly J. Atkins, DPsych, formerly of the UCSF Fein Memory and Aging Center.
Lecanemab is only indicated for patients with mild Alzheimer’s disease and MCI, but collaborative programs can be used for more advanced disease, as well as for 20% to 40% of patients with other types of dementia. The drug may also be out of reach for rural residents who live far from specialist clinics and for low-income patients who struggle to manage out-of-pocket costs.”
Kelly J. Atkins, DPsych
The researchers found that adding lecanemab to treatment increased health care costs by $38,400, but this was offset by the addition of collaborative care. The latter saved $48,000 per patient, in part due to fewer hospital visits. Patients also had an average of four more months at home before moving to a nursing home when they received collaborative care.
“We’re going to see more drugs and better drugs soon, and I think that’s very exciting. But we can’t just focus on drugs, we have to rethink our system of care,” said Professor Katherine L. Possin, PhD, of the UCSF Department of Neurology and the Fein Memory and Aging Center. “Clinics that integrate collaborative care with medicine may be better positioned to meet the needs of patients in this new era of treatment.”
