Economic and Health Consequences of Suboptimal Treatments for Dementia-Related Psychosis Examined in Dr. Nazia Rashid’s Psych Congress 2021 Presentations

Dementia impacts approximately eight million people in the United States, and an estimated 2.4 million Americans experience dementia-related psychosis (DRP). Dr. Nazia Rashid, associate professor of administrative sciences for Keck Graduate Institute (KGI)’s School of Pharmacy and Health Sciences, sheds light on the challenges that DRP presents from a health and economic perspective in three posters featuring new analyses of Medicare claims data on DRP outcomes.

These posters were presented at Psych Congress 2021, held virtually and in-person October 29-November 1, 2021, in San Antonio, TX. They build upon Rashid’s previous award-winning research on DRP health outcomes along with the associated economic burdens.

In addition to the usual cognitive symptoms of dementia, including declining memory and decision-making abilities, those with DRP often experience neuropsychiatric symptoms such as hallucinations and delusions.

DRP often leads to serious consequences, including repeated hospital admissions, increased likelihood of nursing home placement, faster progression of dementia, and increased risk of morbidity and mortality. These events can carry a heavy economic burden on patients and their families.

“To date, no FDA approved drugs are available to treat such symptoms of DRP,” Rashid said. “However, atypical antipsychotics (AAPs) are used off-label to treat these symptoms, despite the absence of quantitative evidence about their effectiveness in treating DRP symptoms.”

AAPs have demonstrated only marginal efficacy, an increased mortality rate, and treatment-emergent adverse events (TEAE). TEAEs are undesirable events that either appear for the first time or worsen in intensity or frequency following medical treatment.

Rashid’s poster, “Treatment-Emergent Adverse Events and Associated Adverse Event-Specific Per-Patient-Per-Year Costs: Analysis of Medicare Beneficiaries Treated with Off-Label Atypical Antipsychotics for Dementia-Related Psychosis,” reveals data from a Medicare claims analysis of 23,267 patients with DRP initiating AAP monotherapy from January 2014 through December 2017.

Of these patients, 70% experienced one or more adverse events (AEs) within one year. This included 64% experiencing dyslipidemia (abnormally elevated cholesterol or fats in the blood), 50% experiencing peripheral vascular disease (PVD, a circulation disorder resulting in reduced blood flow to the limbs), and 40% experiencing cerebrovascular adverse events (CVAEs) such as strokes. Median per-patient-per-year (PPPY) costs of hyperlipidemia, PVD, and CVAE were $5,565, $227 and $3,682, respectively.

Rashid’s presentation, “Incremental Cost of Treatment-Emergent Falls/Fractures, Stroke and Cerebrovascular Adverse Events Among Patients on Atypical Antipsychotics: Analysis of Medicare Patients with Dementia-Related Psychosis,” further explored the poor health outcomes and economic burden associated with AAP treatment of these patients. Approximately one in five patients experienced falls/fractures or stroke (23% and 17%, respectively), while nearly two in five patients (38%) experienced other CVAEs.

The incremental median annual total costs were significantly higher among patients with AEs compared to those without AEs after treatment initiation for falls or fractures ($70,932 vs. $44,221), CVAEs ($68,308 vs. $40,061), and stroke ($74,234 vs. $45,999).

“These results suggest that patients experiencing these adverse events had over 60% higher total annual costs compared with those who did not experience them,” Rashid said.

The third poster, “Incremental Cost of Suboptimal Treatment Outcomes Among Patients with Dementia-Related Psychosis: Analysis of Medicare Beneficiaries,” analyzes the Medicare claims of 35,100 atypical antipsychotic new start patients with DRP. Nearly two out of three patients experienced at least one suboptimal treatment outcome such as treatment augmentation or discontinuation and psychosis-specific hospitalizations.

Median annual total costs were nearly two times higher ($29,898) among patients with suboptimal outcomes than patients who did not experience suboptimal outcomes ($14,158). Total expenses also doubled or quadrupled with the occurrence of two or more or four or more suboptimal outcome events, respectively.

These studies demonstrate how ineffective treatments for dementia-related psychosis have a ripple effect where patients experience increased injuries and hospitalizations as the disease progresses, which in turn increases the costs of managing the disease. Thus, more attention must be placed on analyzing the efficacy of currently available drugs and developing more beneficial treatments down the line.

“Given that Statement 3 of the American Psychiatric Association (APA) recommends (1C) that a patient’s psychiatric evaluation include an assessment of any drugs the patient is currently or recently taking, it’s vital to evaluate if AAPs produce optimal or unsatisfactory treatment outcomes,” Rashid said.