Real-world analysis of medication adherence and cost of care for comorbid conditions in patients with early Alzheimer’s disease in the U.S.

To understand medication adherence and associated healthcare costs of patients with early Alzheimer’s disease (AD). This retrospective cohort study used the Axon Registry® linked with claims data to examine medication adherence of U.S. patients with early AD (mild cognitive impairment [MCI] and mild dementia due to AD) from 2015 to 2022. Medication adherence was quantified by the proportion of days covered (PDC) over a one-year follow-up, and adherence rate was defined at a PDC ≥ 80%. Patient comorbidities and healthcare costs were described. Of 333 patients included, 213 (64%) were female with a median (IQR) age 79 (72–83) years. Patients had a mean (SD) of 2.3 (2.1) comorbidities and took a mean (SD) of 3.0 (1.5) medications. Weighted-average PDC across medications was 74.4% with 7 out of 10 medication classes having a medication adherence rate lower than 60%. DPP-4 inhibitors had the highest medication adherence rate (66.67% of patients), and memantine had the lowest (39.13% of patients). Annual median (IQR) medical and pharmacy costs per-patient were $5,268 ($1,808–$14,651) and $658 ($187–$2,736), respectively. Patients with early AD had multiple comorbidities and took multiple medications. Suboptimal medication adherence and high healthcare costs were observed. This study looked at people in the early stage of their Alzheimer’s disease in the U.S. to understand the extent to which they were taking their medications. It also explored what other health problems those patients had, which medications they took, how often they took their medicine, and how much their healthcare costs were. Patients were chosen based on their scores on a cognitive assessment. Information about their health problems and medications was obtained from their health records. The study found that most patients had many other health issues in addition to Alzheimer’s disease. For these health issues, they were given many different medications. The study found that these patients did not take their medications as regularly as they were supposed to. The costs of medications and medical care were high for these patients. The study suggests that when prescribing medications for people with early Alzheimer’s disease, it is important to consider the comorbidities and manage the associated medication burden.

本研究旨在探讨早期阿尔茨海默病（Alzheimer’s Disease, AD）患者的药物依从性及其相关医疗费用。本项回顾性队列研究依托关联理赔数据的Axon登记库（Axon Registry®），对2015至2022年美国早期AD患者（包括轻度认知障碍[Mild Cognitive Impairment, MCI]及AD所致轻度痴呆患者）的药物依从性展开分析。药物依从性以1年随访期内的覆盖天数比例（Proportion of Days Covered, PDC）进行量化，依从率定义为PDC≥80%的患者占比。本研究同时对患者的共病情况与医疗费用进行描述。纳入分析的333例患者中，213例（64%）为女性，年龄中位数（四分位数间距）为79（72~83）岁。患者的共病数量均值（标准差）为2.3（2.1）种，服用药物的均值（标准差）为3.0（1.5）种。所有药物的加权平均PDC为74.4%，10类药物中有7类的药物依从率低于60%。二肽基肽酶-4（DPP-4）抑制剂的药物依从率最高（66.67%的患者），美金刚（memantine）的依从率最低（39.13%的患者）。每位患者的年度医疗与药品费用中位数（四分位数间距）分别为5268美元（1808~14651美元）与658美元（187~2736美元）。早期AD患者存在多种共病且需服用多种药物，研究观察到其药物依从性欠佳且医疗费用高昂。本研究针对美国早期阿尔茨海默病患者展开，旨在明确其药物服用依从程度，同时探究该类患者的其他健康问题、所服用药物种类、服药频率及医疗费用情况。研究对象基于认知评估得分筛选得出，患者的健康问题与用药信息均来源于其电子健康档案。研究发现，多数患者除阿尔茨海默病外还存在多种其他健康问题，并因此需服用多种不同药物。本研究同时发现，该类患者的药物服用依从性未达理想标准，且其药品与医疗相关费用居高不下。本研究提示，为早期阿尔茨海默病患者开具药物处方时，应充分考量其共病情况并优化相关用药负担。