Frech Feride H, Li Gang, Juday Timothy R, Ding Yingjie, Mattke Soeren, Khachaturian Ara S, Rosenberg Aaron S, Ndiba-Markey Colette, Rava Andrew, Batrla Richard, De Santi Susan, Hampel Harald
Eisai Inc., Nutley, NJ.
Genesis Research Group, Hoboken, NJ.
J Manag Care Spec Pharm. 2025 Aug;31(8):782-794. doi: 10.18553/jmcp.2025.31.8.782.
Mild cognitive impairment (MCI) is a transitional stage before Alzheimer disease and related dementias (ADRD). The link between AD and increased health care resource utilization (HCRU) and costs is well established but not the economic burden of MCI.
To estimate the incremental economic burden of individuals with MCI in the United States.
This was a retrospective cohort study that derived data from the MarketScan Commercial and Medicare Supplemental Databases. The observation period was from January 1, 2014, through December 31, 2019. Included individuals were (1) aged at least 50 years, (2) had at least 2 years of pre-index (ie, date of their first MCI diagnosis) continuous health plan enrollment, and (3) had at least 1 year of post-index continuous health plan enrollment. Individuals were excluded if they had (1) at least 1 claim with a diagnosis of Parkinson disease at any time during the study period, (2) at least 1 claim with a diagnosis of ADRD at any time before the index date, or (3) at least 1 pharmacy claim for an ADRD medication (donepezil, memantine, memantine/donepezil, galantamine, or rivastigmine) at any time before the index date. Outcomes included all-cause HCRU and health care costs for incident MCI individuals (MCI cohort) and matched individuals without MCI or dementia (control cohort) during the 12-month follow-up period. Controls were matched at a 3:1 ratio by age, sex, region, and index year.
In total, 5,185 individuals met the criteria for the MCI cohort and 15,555 for the control cohort. Mean age at baseline was 67 years and 57.7% were female in both cohorts. The MCI cohort had a higher comorbidity burden compared with the control cohort (1.5 vs 1.0 and 2.6 vs 1.8, respectively; < 0.0001) All comorbidities assessed at baseline were more prevalent in the MCI cohort than in the control. Adjusted all-cause HCRU for all points of service and adjusted all-cause mean costs in total ($32,318 vs $13,894; mean ratio [MR] = 2.33, 95% CI = 2.23-2.43), for emergency department ($4,460 vs $3,849; MR = 1.16, 95% CI = 1.08-1.25), outpatient ($16,054 vs $7,265; MR = 2.21, 95% CI = 2.12-2.30), and pharmacy ($5,503 vs $2,933; MR = 1.88, 95% CI = 1.78-1.97) (all < 0.0001) were significantly higher for the MCI cohort.
The economic burden of MCI was more than double that for similar individuals without MCI or dementia. Timely diagnosis and intervention are key to delaying progression to AD and reducing associated costs.
轻度认知障碍（MCI）是阿尔茨海默病及相关痴呆症（ADRD）之前的一个过渡阶段。AD与医疗保健资源利用（HCRU）增加及成本之间的联系已得到充分证实，但MCI的经济负担尚未明确。
评估美国MCI患者的增量经济负担。
这是一项回顾性队列研究，数据来源于MarketScan商业数据库和医疗保险补充数据库。观察期为2014年1月1日至2019年12月31日。纳入的个体需满足以下条件：（1）年龄至少50岁；（2）在索引前（即首次MCI诊断日期）至少连续参保2年；（3）在索引后至少连续参保1年。若个体在研究期间出现以下情况则被排除：（1）至少有1次诊断为帕金森病的理赔记录；（2）在索引日期之前至少有1次诊断为ADRD的理赔记录；（3）在索引日期之前至少有1次ADRD药物（多奈哌齐、美金刚、美金刚/多奈哌齐、加兰他敏或卡巴拉汀）的药房理赔记录。观察指标包括在12个月随访期内，新发MCI个体（MCI队列）和匹配的无MCI或痴呆个体（对照队列）的全因HCRU和医疗保健成本。对照组按年龄、性别、地区和索引年份以3:1的比例进行匹配。
共有5185名个体符合MCI队列标准，15555名个体符合对照队列标准。两个队列的基线平均年龄均为67岁，女性比例均为57.7%。与对照队列相比，MCI队列的合并症负担更高（分别为1.5对1.0和2.6对1.8；P<0.0001）。在基线时评估的所有合并症在MCI队列中比在对照队列中更普遍。MCI队列在所有服务点的调整后全因HCRU以及总计调整后的全因平均成本（32318美元对13894美元；平均比率[MR]=2.33，95%CI=2.23-2.43）、急诊科（4460美元对3849美元；MR=1.16，95%CI=1.08-1.25）、门诊（16054美元对7265美元；MR=2.21，95%CI=2.12-2.30）和药房（5503美元对2933美元；MR=1.88，95%CI=1.78-1.97）（均P<0.0001）均显著更高。
MCI的经济负担是无MCI或痴呆的类似个体的两倍多。及时诊断和干预是延缓进展为AD并降低相关成本的关键。
