Economic Disparity in Alzheimer’s Treatment
Writer: Sara Al-Shoaibi
Editor: Vijaya Varadarajan
There has always been disparity in every aspect of our lives, but what about our healthcare system, or more specifically our Alzheimer’s treatment system? And is it just with treatment, what about in actual diagnoses? Should there even be disparity when it comes to diagnoses? Many studies have been conducted, and it has been proven that not only is our healthcare system flawed when it comes to treating people with Alzheimer’s Disease, but many find out too late because of the daily inequality many already face in their lives. The question “Should there even be disparity when it comes to diagnoses?” is an obvious and unnecessary question. No there shouldn’t, but it doesn’t matter. The simple truth is that there is. Which is why we have to talk about it. In the 21st century, raising social matters to the public eye has been deemed to be impactful, so why not shine a spotlight on this matter? “1 in 9 people(10.8%) age 65 and older have Alzheimer’s disease”(Texas DSHS), and with “someone in the world [developing] dementia every 3 seconds”(ADI), that number is far too low to trust.
Alzheimer’s disease is the precursor to dementia for “60-80% of all”(Alzheimer Society of Canada) diagnosed patients. If someone is developing dementia every 3 seconds, then there is a high chance of them subsequently acquiring Alzheimer’s. The interesting aspect of Alzheimer’s is that it’s a silent specter before tiptoeing in the corridors of the brain. Since AD is an intricate disease, diagnosis and treatment carry the weight of costly burdens.
Currently, there are medications: memantine, donepezil, the rivastigmine patch, brexpiprazole, galantamine to help manage Alzheimer’s symptoms. These medications can cost up to $10,000 yearly. Then there is the new treatment for Alzheimer’s, Leqembi, that the FDA has recently approved. Clinical trial results showed that the new drug “slowed the rate of cognitive decline and reduced amyloid plaques, the protein that accumulates in the brains of people with Alzheimer’s disease”. Right now, Leqembi has a list price of $26,500 -
Let’s take a quick break to clarify the elephant in the room. Many would be bewildered by the distinction between a list price and the actual amount one pays for. List prices is the price that it took to actually manufacture the drug including research and development, marketing, profit margins. The entire process of getting the list price to retail price is way too lengthy and in actuality very misleading to the actual value of the product.
- and “Medicare patients administered the drug will be responsible for more than $5,000 out of pocket each year.”(KFF) This is just the pricing of medication. What about families that don’t have the resources or time to take care of their family members who are influenced by Alzheimer’s? “Costs for formal care average $27, 672 per patient annually”, while “annual costs for informal care are estimated to be $10,400 to $34,517 per patient.”(The American Journal of Managed Care, pp. 809-818)
The burden of AD doesn’t stop at costs, to make matters worse, the interplay of race weaves through the narrative too:
In receiving diagnoses, “it took 11% longer for Black Americans and 40% longer for Hispanic Americans.”
“Asian Americans older adults were less likely to receive a diagnostic work-up[a complete medical examination] for cognitive impairment.”
“Black and Hispanic American patients were less likely to be referred for neuropsychological testing.”
“Minoritized populations had lower rates of prescriptions for anti-dementia medications”
“Hispanic and Black American older adults had higher discontinuation rates of anti-dementia medications.”(News)
Disparities also exist in Alzheimer’s care.
“Black Americans with dementia were more likely to have increased hospital admission rates, longer lengths of stay and higher costs.”
“Minoritized populations living with dementia were less likely to be in long-term care facilities with special memory care units.”
“Caregivers of Black Americans with dementia were less likely to fill out advanced care directives.”
“Black Americans with dementia were less likely to receive hospice care and more likely to receive feeding tubes and mechanical ventilation during end-of-life care.”
In conclusion, the journey towards equitable treatment and diagnosis in Alzheimer’s disease demands our relentless attention and consideration. We must work together to try and bridge the gap between the economic disparity and hopefully even find a. By moving past our differences, can we start to truly understand how this disease affects us and what it will take to stop it from spreading.
References
“What Is Alzheimer’s Disease? Questions and Answers | Texas DSHS.” Www.dshs.texas.gov, www.dshs.texas.gov/alzheimers-disease/about-alzheimers-disease/what-is-alzheimers-disease#:~:text=About%201%20in%209%20people.
“ADI - Dementia Statistics.” Alzheimer’s Disease International, www.alzint.org/about/dementia-facts-figures/dementia-statistics/#:~:text=Someone%20in%20the%20world%20develops.
“The Difference between Alzheimer’s Disease and Other Dementias.” Alzheimer Society of Canada, alzheimer.ca/en/about-dementia/what-alzheimers-disease/difference-between-alzheimers-disease-other-dementias#:~:text=Dementia%20is%20not%20one%20specific.
“New Alzheimer’s Drugs Spark Hope for Patients and Cost Concerns for Medicare.” KFF, 6 July 2023, www.kff.org/policy-watch/new-alzheimers-drugs-spark-hope-for-patients-and-cost-concerns-for-medicare/.
Rice, D. P., et al. “Prevalence, Costs, and Treatment of Alzheimer’s Disease and Related Dementia: A Managed Care Perspective.” The American Journal of Managed Care, vol. 7, no. 8, 1 Aug. 2001, pp. 809–818, pubmed.ncbi.nlm.nih.gov/11519239/.
News. “Study Finds Disparities in Diagnosis and Treatment of Dementia.” News, health.ucdavis.edu/news/headlines/study-finds-disparities-in-diagnosis-and-treatment-of-dementia/2024/01#:~:text=Disparities%20in%20end%2Dof%2Dlife%20care&text=Black%20Americans%20with%20dementia%20were.
Hinton, Ladson, et al. “Mapping Racial and Ethnic Healthcare Disparities for Persons Living with Dementia: A Scoping Review.” Alzheimer’s & Dementia, 24 Jan. 2024, https://doi.org/10.1002/alz.13612.
