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.

本研究旨在明确早期阿尔茨海默病（Alzheimer’s Disease, AD）患者的药物依从性及其相关医疗成本。本项回顾性队列研究借助与理赔数据关联的Axon Registry®数据库，对2015年至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。本研究以1年随访期内的药物覆盖天数比例（Proportion of Days Covered, PDC）量化药物依从性，并将PDC≥80%定义为良好药物依从，同时对患者的共病情况与医疗成本进行描述。

纳入研究的333例患者中，213例（64%）为女性，年龄中位数（四分位间距[Interquartile Range, IQR]）为79（72~83）岁。患者的共病数量均值（标准差[Standard Deviation, SD]）为2.3（2.1）种，服用药物的均值（标准差）为3.0（1.5）种。所有受试药物的加权平均PDC为74.4%，10类药物中有7类的药物依从率低于60%。其中二肽基肽酶-4抑制剂（DPP-4 inhibitors）的药物依从率最高，66.67%的患者达到良好依从标准；美金刚（memantine）的依从率最低，仅为39.13%。每位患者的年度医疗费用中位数（四分位间距）为5268美元（1808~14651美元），药品费用中位数（四分位间距）为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。本研究观察到该群体存在药物依从性欠佳及医疗成本高昂的问题。本研究针对美国早期阿尔茨海默病患者，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、所服药物种类、服药频率及医疗成本情况。受试者通过认知评估得分筛选入组，其健康问题与用药信息均来源于医疗记录。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，因此需服用多种不同药物；同时该群体未按医嘱规律服药，药物与医疗费用均处于较高水平。本研究提示，为早期阿尔茨海默病患者开具药物处方时，应充分考虑其共病情况，并对相关用药负担进行合理管理。