DCC: Cost of Alzheimer's Drugs Pales in Comparison with Treatment for Comorbidities

By Crystal Phend
GARDEN GROVE, Calif., 29 aug 2008-- Most of the amount spent on medications for patients with Alzheimer's disease goes to treat other conditions, researchers found.
Drugs to treat Alzheimer's accounted for less than a third of patients' total prescription costs, reported Anna Theodorou, R.Ph., of CVS Caremark in Scottsdale, Arizona, and colleagues, at the Alzheimer's Association Dementia Care Conference here.
These findings from a prescription claims database put costs into perspective, Theodorou said.
"A lot of physicians feel the number one reason for drug discontinuation is cost," she said.
Alzheimer's patients often have multiple comorbidities that contribute to higher annual prescription costs than seen among adults without Alzheimer's, the researchers noted.
But the Alzheimer's-specific medications might have been expected to contribute a larger proportion of drug costs, commented Elizabeth Gould, L.C.S.W., of the Alzheimer's Association, in an interview.
"Most of the medications used to treat Alzheimer's disease are new" without a generic option, she noted.
Theodorou's group had previously studied drug utilization in Caremark's computerized prescription claims database in 2005 before Medicare Part D came into effect.
So they revisited the database, doing a retrospective study of the 367 million prescription claims in the database for 2006 among the 22.9 million members covered by prescription plans administered by Caremark.
These plans included those for Medicaid, Medicare Part D, national and local employers, managed care organizations, and government agencies.
Among the members included in the 2006 analysis, 107,236 used Alzheimer's drug therapy with a particularly high rate among members ages 75 to 84 (663.5 per 10,000 eligible members).
Use of Alzheimer's drugs rose substantially over 2005 (46.7 versus 27.0 users per 10,000 eligible members), primarily because of the introduction of the Medicare Part D benefit, the researchers said.
Donepezil (Aricept) dominated the market, prescribed for 69.6% of all Alzheimer's drug users. The drug also accounted for 52.2% of all Alzheimer's drug prescriptions and 54.4% of drug costs.
Memantine (Namenda) was used by 40.7% of Alzheimer's drug users and accounted for 31.9% of prescriptions and 28% of drug costs.
Although patients taking Alzheimer's drugs averaged a total prescription cost of $3,990 per user annually, only $1,054 of that cost was for Alzheimer's drugs (26%).
Other medication classes accounted for most of the costs. These agents included:
Statins at 8.1% of annual non-Alzheimer's drug costs, which were used by 43.9% of Alzheimer's patients.
Proton pump inhibitors at 6.6% of annual non-Alzheimer's drug costs, which were used by 34.2% of Alzheimer's patients.
Dibenzapines, used by 17.5% of Alzheimer's patients and accounting for 6.5% of yearly non-Alzheimer's drug costs.
Selective serotonin reuptake inhibitors at 5.5% of annual non-Alzheimer's drugs costs and used by 46.3% of Alzheimer's patients.
Altogether, patients who filled a prescription for at least one Alzheimer's drug had lower out-of-pocket costs than other adults insured in Caremark's array of private and public insurers. The average contribution to prescription costs was 16% for Alzheimer's drug users compared with 21.7% for the average member.
The reason for this difference may be that a higher proportion of the Alzheimer's patients were on Medicare or Medicaid, Theodorou suggested.
Theodorou reported being employed by CVS Caremark, which was responsible for the study. Gould reported no conflicts of interest.
Primary source: Dementia Care ConferenceSource reference:Theodorou A, et al "Utilization of Alzheimer Agents in the United States" DCC 2008; PS-22.