Prevalence of dementia and medication use patterns among Indiana Medicaid beneficiaries

Murtuza Fakhruddin Bharmal, Purdue University

Abstract

This study was undertaken to estimate the prevalence of dementia among Indiana Medicaid beneficiaries in 2003 and to examine patterns of medication use among patients with dementia. The study developed and validated criteria to identify patients with dementia from medical claims data. The use of dementia-indicated drugs, antipsychotic drugs and anticholinergic drugs among patients with dementia in 2003 was assessed. The study also assessed associations between use of dementia-indicated drugs with sociodemographic characteristics, health care utilization and expenditures among patients with dementia. A combination of retrospective data and primary expert panel survey data was used for addressing the research questions. The retrospective data used were the Indiana Medicaid eligibility and claim files for the period July 1, 2001 to December 31, 2003. A total of 26 ICD codes were rated as specific for diagnosis of dementia by expert panel members from 47 ICD codes that were identified from literature for identifying patients with dementia. The prevalence of dementia was 11 percent among individuals age 50 years or older and 14 percent among individuals age 60 years or older. This represented a 2.5 times to 3.5 times increase in prevalence of dementia compared to studies in Medicaid populations approximately 10 years earlier. The use of dementiaindicated drugs among patients with dementia was low at 34.4 percent compared to the use of antipsychotic drugs (50.4%) and anticholinergic drugs (60.8%). Change in number of hospitalizations was 0.21 lower among dementia-indicated drug users compared to dementia-indicated drug non-users. Dementia-indicated drug users also had 49 percent lower risk of hospitalization compared to patients with dementia that did not use dementia-indicated drugs. After adjusting for multiple covariates, dementia-indicated drug users had $98 lower change in outpatient expenditures, $171 lower change in physician-related expenditures, $614 higher change in nursing home expenditures and $697 higher change in prescription drug expenditures compared to dementia-indicated drug non-users. However, there were no significant differences in the adjusted change in total expenditures between dementia-indicated drug users and dementia-indicated drug non-users. The study findings indicate that the use of dementia-indicated drugs among patients with dementia living in community setting is recommended on account of better clinical outcomes with no significant change in total expenditures associated with their use.

Degree

Ph.D.

Advisors

Thomas, Purdue University.

Subject Area

Pharmaceuticals|Public health|Social research

COinS