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Dr. Nazia Rashid Earns Two Awards for Research on The Economic Impact of Treating Dementia-Related Psychosis in the U.S.

Dr. Nazia Rashid, Associate Professor of Administrative Sciences for Keck Graduate Institute (KGI)’s School of Pharmacy and Health Sciences, earned two awards for her research on the economic impact of dementia patients with psychosis during the academic school year of 2020-2021. And in May 2021, she received an international achievement and recognition award for her presentation at The International Society of Pharmacoeconomics and Research Conference (ISPOR).

This presentation, “Cost of Illness Analysis of Dementia-Related Psychosis in the U.S. from a Societal Perspective study,” evaluated the economic impact of psychosis in dementia patients versus dementia patients without psychosis.

Dementia is a group of conditions characterized by impairment of brain functions such as memory loss and judgment to the point that it interferes with daily functioning. Approximately 20-70% of dementia patients suffer from hallucinations and/or delusions, a characteristic hallmark of dementia-related psychosis (DRP).

DRP may accelerate cognitive decline among patients with dementia and may have debilitating consequences on patients, caregivers, and society. However, the economic burden of DRP has not been well-studied to date.

Thus, in this study, Rashid and her colleagues used a pharmacoeconomic model to conduct a comprehensive cost-of-illness economic analysis to lend greater clarity to the societal burden and associated costs of DRP in the U.S.

“With the aging of the population, dementia is increasing along with Parkinson’s disease,” Rashid said.

“All of these diseases are increasing in parallel because people are living longer, so this has become a pretty substantial healthcare issue.”

The study observed patients in various stages of DRP, from newly diagnosed to moderate to severe psychosis to those who had entered long-term care (LTC)/nursing homes. Both direct and indirect costs rose incrementally as patients progressed through the various stages of DRP.

Direct costs encompass service costs, including hospitalizations, nursing facility, home healthcare, medical equipment, prescription medications, and nursing home costs. Indirect costs are paid by the patients and their families and include formal out-of-pocket costs for healthcare and informal caregiver costs.

For 2020, the average direct cost for Medicare patients with mild DRP was $42,806, while costs ran up to $136,061 for LTC Medicare patients. In this same category, indirect costs totaled $7,921 (mild DRP) and $21,875 (LTC).

Figures for commercial patients showed similar rates of increase. Total annual direct costs for both Medicare and commercial patients with all levels of DRP came out to $141 billion, while indirect yearly costs amounted to $122 billion.

In addition to her recent ISPOR research recognition, Rashid received a silver ribbon award for her poster presentation on “Healthcare Resource Utilization and Associated Costs for Dementia Patients with Psychosis: A Medicare Database Study,” presented at the American Academy of Managed Care Pharmacy conference in October 2020. In this poster, Rashid and her colleagues provided a breakdown of the various expenses, including ER visits, outpatient visits, prescriptions, and hospitalizations that are incurred once a dementia patient is diagnosed with psychosis using a commercial medicare database.

“You see this huge incremental difference in the first year of these dementia patients being newly diagnosed with psychosis because they’re seeing doctors more often,” Rashid said. “And this is an issue globally, not just in the U.S. Once people start experiencing psychosis, they see a natural downhill progression of their health along with an increase in medical expenses.”

The study found that the mean cost per patient per year for inpatient stays was $9,989 during the baseline period (before a dementia patient is diagnosed with DRP). It jumped by 2.6-fold—to a mean of $25,982—during the first follow-up year. Mean all-cause LTC costs also had the most significant increase from pre-index in the year following the start of dementia-related psychosis ($15,060 to $24,495) but then appeared to increase steadily over time.

Patterns for psychosis-related healthcare resource utilization (HCRU) and costs over time were similar to all-cause HCRU and costs. The most frequently used psychosis-related resources were prescription drug fills and doctor visits.

Mean total psychosis-related Medicare costs were $955 in the year pre-index, increased to $6,663 in the year post-index, and remained above baseline in subsequent years. Overall, it is clear that in the year following psychosis diagnosis in patients with dementia, both HCRU and costs increased substantially from the year prior.

These results point to the need for earlier detection of DRP and management strategies and treatments that can reduce HCRU and costs.

“We’re looking into alternative therapies and determining whether or not the standard of care for these patients is efficacious,” Rashid said.

Rashid’s background is in health economics and outcomes research, where she performs database analysis for various conditions, including diabetes, psychosis, and rheumatoid arthritis. As a KGI professor and Co-Advisor for Academy of Managed Care Pharmacy (AMCP) and California Pharmacy Student Leadership (CAPSLEAD), she teaches students how to critically assess medical literature and drug information, perform economic modeling for costs associated with therapies and interventions, and socialize and disseminate statistics.

“I am very honored to have received these two awards and was super surprised,” Rashid said. “It is not easy to complete a cost of illness study from a societal perspective, but that was the approach we wanted to take. It was a lot of work, but we received the benefit of completing a good project.”