Professionally, I am a data analyst, medical writer, and storyteller. Personally, my dad had Alzheimer's disease. I fell in love with him all over again. Over the years since he has been gone I noticed a few things. There were many similarities in his disease progression but also many unique elements. Why are so many behaviors the same between patients? What generates the profound differences?
I have been writing about health economics and quickly became aware of the inefficiencies in healthcare that are driving our costs and straining already limited resources. Have you ever wondered what happened to senility? Well, in a nutshell it had a trillion dollar re-brand as Alzheimer's disease...
What if the real scientific findings are much less EUREKA, and more like--hmmm, that looks interesting?
The most exciting phrase to hear in science, the one that heralds new discoveries, is not “Eureka!” (I found it!) but “That’s funny …”
The story I want to tell is the evolution of dementia from pre-Alzheimer's diagnosis to a multibillion dollar healthcare juggernaut. I want to understand why we continue to fund inaccurate disease models at a profound rate but refuse to make comparable investments in upstream drivers of pathologic senescence.
Costs of Care
In 2015, the costs to all payers for the care of people living with Alzheimer’s disease and other dementias will total an estimated $226 billion, with Medicare and Medicaid paying 68 percent of the costs. Based on the current trajectory, costs are projected to increase to over $1.1 trillion in 2050, with Medicare and Medicaid costs increasing to nearly 70 percent of the total. The Figure illustrates these costs paid by Medicare, Medicaid, affected individuals and their families, and other payers such as private insurance, HMOs and other managed care organizations, and those that cover uncompensated care.
Nearly one in five Medicare dollars — or 18 percent— will be spent on people living with Alzheimer’s and other dementias in 2015. Medicare costs will increase over 420 percent, from $113 billion in 2015 to $589 billion in 2050. This is projected to represent nearly one in three Medicare dollars. Medicaid costs will increase about 330 percent from $41 billion in 2015 to $176 billion in 2050. Similarly, out-of-pocket costs for individuals and families affected by Alzheimer’s and other dementias will increase about 350 percent from $44 billion in 2015 to $198 billion in 2050. Costs to other payers will increase about 375 percent from $29 billion in 2015 to $138 billion in 2050.
Here are the updated 2018 figures below and a graphic of the timeline as well.
The NIH has invested considerable funds into research for Alzheimer's disease as well as other dementias. If we ever develop a monotherapeutic cure the cost will be astronomical. It will be interesting to witness that health economics and policy debate. Meanwhile, many of us would like to see investments in prevention through targeting of social correlates of health and lifelong measures potentially on the high risk side of chronic disease.
The pending zombie apocalypse marketed to millions of us as we age creates a panic and desperation. It also makes us dig into our wallets and donate to causes with unproven track records and dubious allotment of funds. Gillette made a brilliant award winning commercial about what it means to care for a loved one with a chronic and debilitating illness. Solutions, not fear mongering wins the day.
I hope you will follow the blog, join the conversations @datamongerbonny and keep the faith.