Programs that match caregivers with patient navigators yield better outcomes than Alzheimer'sdrug – but combining the two may be best.
A Medicare-covered program that offers support and medical advice for caregivers of patients with dementia may bring more benefit than a costly Alzheimer's medication, new research finds.
UC San Francisco researchers compared outcomes for patients in collaborative care programs with those taking lecanemab, one of two approved drugs that have been shown to slow progression of Alzheimer's in some patients.
UCSF Health was an early leader in developing a collaborative care program with the Care Ecosytem , which supports patients and caregivers. Paid navigators coordinate with clinical teams and connect caregivers to community resources. The program has informed similar efforts and has been adopted and adapted by more than 50 health systems nationwide.
Collaborative care improved quality of life, reduced costs, alleviated caregiver burden, and extended the time that patients remained in the community before entering a nursing facility, as compared to lecanemab. Results were published Feb. 5 in Alzheimer's and Dementia: Behavior and Socioeconomics of Aging.
The researchers created a simulated cohort of 1,000 patients using data from previous studies. About half had mild Alzheimer's and half had mild cognitive impairment (MCI), which precedes it. Replacing usual care with collaborative care gave patients an extra 0.26 quality-adjusted life years (QALYs), a measure that reflects living longer in better health. When lecanemab was added to collaborative care, patients gained another 0.16 QALYs.
Collaborative care can serve a broader population than medication, said first author Kelly J. Atkins, DPsych, formerly of the UCSF Fein Memory and Aging Center .
"Lecanemab is only indicated for patients with mild Alzheimer's and MCI, but collaborative programs can be used for more advanced disease, as well as for the 20% to 40% of patients with other types of dementia," she said. "The drug may also be out of reach for rural residents living far from specialty clinics, and for low-income patients struggling to manage out-of-pocket costs."
The researchers found adding lecanemab to treatment increased health care costs by $38,400, but this was offset by adding collaborative care. The latter saved $48,000 per patient, partially due to fewer hospital visits. Patients also had, on average, four more months at home before transitioning to a nursing home when they received collaborative care.
"We're going to see more drugs and better drugs soon, and I think that's very exciting. But we can'tjust focus on the drugs, we need to rethink our system of care," said Professor Katherine L. Possin , PhD, of the UCSF Department of Neurology and the Fein Memory and Aging Center. "Clinics that integrate collaborative care with the drugs may be best positioned to meet the needs of patients in this new treatment era."
Journal: Alzheimer's & Dementia: Behavior and Socioeconomics of Aging
Co-Author: James G. Kahn , MD, MPH, of UCSF
Funding: National Institute on Aging (RO1 AG074710) and the Alzheimer's Association
Disclosures: Please see the paper
About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health , which serves as UCSF's primary academic medical center, includes among the nation's top specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at ucsf.edu or see our Fact Sheet .
