@article {12313, title = {Public spending on acute and long-term care for Alzheimer{\textquoteright}s disease and related dementias.}, journal = {Alzheimer{\textquoteright}s \& Dementia}, year = {Forthcoming}, abstract = {

INTRODUCTION: We estimate the spending attributable to Alzheimer{\textquoteright}s disease and related dementias (ADRD) to the United States government for the first 5 years post-diagnosis.

METHODS: Using data from the Health and Retirement Study matched to Medicare and Medicaid claims, we identify a retrospective cohort of adults with a claims-based ADRD diagnosis along with matched controls.

RESULTS: The costs attributable to ADRD are $15,632 for traditional Medicare and $8833 for Medicaid per dementia case over the first 5 years after diagnosis. Seventy percent of Medicare costs occur in the first 2 years; Medicaid costs are concentrated among the longer-lived beneficiaries who are more likely to need long-term care and become Medicaid eligible.

DISCUSSION: Because the distribution of the incremental costs varies over time and between insurance programs, when interventions occur and the effect on the disease course will have implications for how much and which program reaps the benefits.

}, keywords = {longitudinal costs, Medicaid, Medicare, Spending}, issn = {1552-5279}, doi = {10.1002/alz.12657}, author = {Norma B Coe and White, Lindsay and Oney, Melissa and Basu, Anirban and Larson, Eric B} } @article {11103, title = {Dementia Is Associated With Earlier Mortality for Men and Women in the United States.}, journal = {Gerontology and Geriatric Medicine}, volume = {6}, year = {2020}, pages = {2333721420945922}, abstract = {

Sociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. Our study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, we identified a retrospective cohort of adults with at least one International Classification of Diseases-ninth revision-Clinical Modification (ICD-9-CM) dementia diagnosis code ( = 3,714). For each case, we randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year ( = 9,531), and assigned comparators the diagnosis date of their matched case. Participants were followed for up to 60 months following diagnosis. We estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. On average, dementia cases were 80.5 years old at diagnosis. Most were female, had less than college-level education, and approximately 40\% were married at diagnosis. In multivariate analyses, dementia diagnosis was associated with earlier mortality for women (predicted median survival of 54.5 months vs. 62.5 months; dementia coefficient = -0.13; 95\% confidence interval [CI] = [-0.22, -0.04]; = .003), but even more so among men (predicted median survival of 35.5 months vs. 54.5 months; dementia coefficient = -0.42; 95\% CI = [-0.52, -0.31]; < .001). We found substantial heterogeneity in the relationship between dementia and survival, associated with both education and marital status. Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.

}, keywords = {Dementia, gender, Medicare, Medicare administrative data}, issn = {2333-7214}, doi = {10.1177/2333721420945922}, author = {White, Lindsay and Fishman, Paul and Basu, Anirban and Paul K Crane and Eric B Larson and Norma B Coe} } @article {11134, title = {Difficulty with Taking Medications Is Associated with Future Diagnosis of Alzheimer{\textquoteright}s Disease and Related Dementias.}, journal = {Journal of General Internal Medicine}, year = {2020}, abstract = {

BACKGROUND: Medication management requires complex cognitive functioning, and therefore, difficulty taking medications might be an early sign of cognitive impairment and could be a risk factor for Alzheimer{\textquoteright}s disease and related dementias (ADRD). Accordingly, people with difficulty taking medications may benefit from more detailed cognitive screening, potentially aiding in the diagnosis of ADRD, which is underdiagnosed. We are unaware of evidence on medication management difficulties that precede a real-world ADRD diagnosis in the USA.

OBJECTIVE: Examine the association between difficulty taking medications and subsequent real-world ADRD diagnoses.

DESIGN: Case-control study, using Health and Retirement Study (HRS) survey data linked to Medicare claims.

PARTICIPANTS: A total of 1461 HRS respondents with an ADRD diagnosis observed from 1993 to 2012 (cases), matched by year of birth, wave of HRS entry, and sex to 3771 controls with no ADRD diagnosis.

MAIN MEASURES: We examined the association between diagnosis of ADRD and self-reported difficulty taking medications in the preceding years (1-2 and 3-4~years prior to case definition). Control individuals were assigned the index date from their matched case. Conditional logistic regressions adjusted for age, sex, race, education, and comorbidities.

KEY RESULTS: Compared with matched controls, cases had higher prevalence of difficulty taking medications 1-2~years prior to diagnosis (11.0\% versus 2.3\%), and 3-4~years prior to diagnosis (5.8\% versus 2.3\%). Adjusted analyses showed that compared with individuals without ADRD, those with an ADRD diagnosis had more than four times higher odds of difficulty taking medications 1-2~years prior (OR = 4.56 (CI 3.30-6.31)), and more than two times higher odds of difficulty taking medications 3-4~years prior (OR = 2.41 (CI 1.61-3.59)).

CONCLUSIONS: Odds of medication difficulty 1-2~years prior were more than four times greater for individuals with ADRD diagnoses compared with those without ADRD. Medication management difficulties may prompt further cognitive screening, potentially aiding in earlier recognition of ADRD.

}, keywords = {Alzheimer{\textquoteright}s disease and related dementias, cognitive screening, medication management}, issn = {1525-1497}, doi = {10.1007/s11606-020-06279-y}, author = {Douglas Barthold and Marcum, Zachary A and Chen, Shuxian and White, Lindsay and Ailabouni, Nagham and Basu, Anirban and Norma B Coe and Gray, Shelly L} } @article {10063, title = {Medicare expenditures attributable to dementia.}, journal = {Health Services Research}, year = {2019}, abstract = {

OBJECTIVE: To estimate dementia{\textquoteright}s incremental cost to the traditional Medicare program.

DATA SOURCES: Health and Retirement Study (HRS) survey-linked Medicare part A and B claims from 1991 to 2012.

STUDY DESIGN: We compared Medicare expenditures for 60~months following a claims-based dementia diagnosis to those for a randomly selected, matched comparison group.

DATA COLLECTION/EXTRACTION METHODS: We used a cost estimator that accounts for differential survival between individuals with and without dementia and decomposes incremental costs into survival and cost intensity components.

PRINCIPAL FINDINGS: Dementia{\textquoteright}s five-year incremental cost to the traditional Medicare program is approximately $15~700 per patient, nearly half of which is incurred in the first year after diagnosis. Shorter survival with dementia mitigates the incremental cost by about $2650. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services. The incremental cost of dementia was about $7850 higher for females than for males because of sex-specific differential mortality associated with dementia.

CONCLUSIONS: Dementia{\textquoteright}s cost to the traditional Medicare program is significant. Interventions that target early identification of dementia and preventable inpatient and post-acute care services could produce substantial savings.

}, keywords = {Cognition \& Reasoning, Dementia, Medicare linkage, Medicare/Medicaid/Health Insurance}, issn = {1475-6773}, doi = {10.1111/1475-6773.13134}, author = {Lindsay L Waite and Fishman, Paul and Basu, Anirban and Paul K Crane and Eric B Larson and Norma B Coe} } @article {9603, title = {2SLS versus 2SRI: Appropriate methods for rare outcomes and/or rare exposures}, journal = {Health Economics}, volume = {27}, year = {2018}, month = {Jan-06-2018}, pages = {937 - 955}, abstract = {This study used Monte Carlo simulations to examine the ability of the two-stage least squares (2SLS) estimator and two-stage residual inclusion (2SRI) estimators with varying forms of residuals to estimate the local average and population average treatment effect parameters in models with binary outcome, endogenous binary treatment, and single binary instrument. The rarity of the outcome and the treatment was varied across simulation scenarios. Results showed that 2SLS generated consistent estimates of the local average treatment effects (LATE) and biased estimates of the average treatment effects (ATE) across all scenarios. 2SRI approaches, in general, produced biased estimates of both LATE and ATE under all scenarios. 2SRI using generalized residuals minimized the bias in ATE estimates. Use of 2SLS and 2SRI is illustrated in an empirical application estimating the effects of long-term care insurance on a variety of binary health care utilization outcomes among the near-elderly using the Health and Retirement Study.}, keywords = {Clinical trials, Health Care Outcomes, Insurance, Monte-Carlo Simulations}, issn = {10579230}, doi = {10.1002/hec.v27.610.1002/hec.3647}, url = {http://doi.wiley.com/10.1002/hec.v27.6http://doi.wiley.com/10.1002/hec.3647http://onlinelibrary.wiley.com/wol1/doi/10.1002/hec.3647/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002\%2Fhec.3647}, author = {Basu, Anirban and Norma B Coe and Cole G. Chapman} } @article {9057, title = {2SLS vs 2SRI: Appropriate methods for rare outcomes and/or rare exposures}, journal = {Health Economics}, volume = {27}, year = {2018}, pages = {937-955}, type = {Journal}, abstract = {Using Monte-Carlo simulations, we compare the two-stage least-squares estimator with two-stage residual inclusion estimators, with varying forms of residuals, to estimate the local average treatment effect parameter for a binary outcome and endogenous binary treatment model in the presence of binary covariates and a binary instrumental variable. We vary the rarity of both the outcome and the treatment and find different estimators to produce the least bias in different settings. We develop guidance for applied researchers and illustrate the utility of this guidance with estimating the effects of long-term care insurance on a variety of binary health care use outcomes among the near-elderly using the Health and Retirement Study.}, keywords = {Health Care Outcomes, Monte-Carlo Simulations}, doi = {10.1002/hec.3490}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3647}, author = {Basu, Anirban and Norma B Coe} } @article {9332, title = {Comparing 2SLS vs 2SRI for Binary Outcomes and Binary Exposures}, number = {Working Paper No. 23840}, year = {2017}, month = {09/2017}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {This study uses Monte Carlo simulations to examine the ability of the two-stage least-squares (2SLS) estimator and two-stage residual inclusion (2SRI) estimators with varying forms of residuals to estimate the local average and population average treatment effect parameters in models with binary outcome, endogenous binary treatment, and single binary instrument. The rarity of the outcome and the treatment are varied across simulation scenarios. Results show that 2SLS generated consistent estimates of the LATE and biased estimates of the ATE across all scenarios. 2SRI approaches, in general, produce biased estimates of both LATE and ATE under all scenarios. 2SRI using generalized residuals minimizes the bias in ATE estimates. Use of 2SLS and 2SRI is illustrated in an empirical application estimating the effects of long-term care insurance on a variety of binary healthcare utilization outcomes among the near-elderly using the Health and Retirement Study.}, keywords = {Economics, Health Services Utilization, Long-term Care}, doi = {10.3386/w23840}, url = {http://www.nber.org/papers/w23840.pdf}, author = {Basu, Anirban and Norma B Coe and Cole G. Chapman} }