Real-world health care costs and resource utilization associated with mild cognitive impairment in the United States: A retrospective cohort study of commercial and Medicare data.

Abstract

Background: Mild cognitive impairment (MCI) is a transitional stage before Alzheimer disease and related dementias (ADRD). The link between AD and increased health care resource utilization (HCRU) and costs is well established but not the economic burden of MCI.

Objective: To estimate the incremental economic burden of individuals with MCI in the United States.

Methods: This was a retrospective cohort study that derived data from the MarketScan Commercial and Medicare Supplemental Databases. The observation period was from January 1, 2014, through December 31, 2019. Included individuals were (1) aged at least 50 years, (2) had at least 2 years of pre-index (ie, date of their first MCI diagnosis) continuous health plan enrollment, and (3) had at least 1 year of post-index continuous health plan enrollment. Individuals were excluded if they had (1) at least 1 claim with a diagnosis of Parkinson disease at any time during the study period, (2) at least 1 claim with a diagnosis of ADRD at any time before the index date, or (3) at least 1 pharmacy claim for an ADRD medication (donepezil, memantine, memantine/donepezil, galantamine, or rivastigmine) at any time before the index date. Outcomes included all-cause HCRU and health care costs for incident MCI individuals (MCI cohort) and matched individuals without MCI or dementia (control cohort) during the 12-month follow-up period. Controls were matched at a 3:1 ratio by age, sex, region, and index year.

Results: In total, 5,185 individuals met the criteria for the MCI cohort and 15,555 for the control cohort. Mean age at baseline was 67 years and 57.7% were female in both cohorts. The MCI cohort had a higher comorbidity burden compared with the control cohort (1.5 vs 1.0 and 2.6 vs 1.8, respectively; P < 0.0001) All comorbidities assessed at baseline were more prevalent in the MCI cohort than in the control. Adjusted all-cause HCRU for all points of service and adjusted all-cause mean costs in total ($32,318 vs $13,894; mean ratio [MR] = 2.33, 95% CI = 2.23-2.43), for emergency department ($4,460 vs $3,849; MR = 1.16, 95% CI = 1.08-1.25), outpatient ($16,054 vs $7,265; MR = 2.21, 95% CI = 2.12-2.30), and pharmacy ($5,503 vs $2,933; MR = 1.88, 95% CI = 1.78-1.97) (all P < 0.0001) were significantly higher for the MCI cohort.

Conclusions: The economic burden of MCI was more than double that for similar individuals without MCI or dementia. Timely diagnosis and intervention are key to delaying progression to AD and reducing associated costs.