Programs that support caregivers of patients with dementia could bring substantial benefits at a fraction of the price of an Alzheimer’s drug.
A computer simulation guided by patient data from prior studies found that supportive care reduced health care costs and scored higher than the drug intervention on a common measure of treatment value, researchers report February 5 in Alzheimer’s and Dementia: Behaviour & Socioeconomics of Aging. though not based on direct patient observations, the conclusions highlight the impact of improving care coordination as dementia cases rise.
Disease-slowing Alzheimer’s drugs entered the market in the last few years. But dementia specialists are scarce, leaving care for the estimated 6.7 million Americans living with Alzheimer’s and other forms of dementia largely to time- and resource-strapped primary care doctors.
To help families navigate this fragmented health care system, researchers at the University of California, San Francisco pair caregivers with individuals who provide dementia-related support and information. Through a decade-old Medicare-covered program, these care navigators phone families monthly and answer questions related to medications, sleep or behavior as needed. They also connect caregivers with specialists including clinicians, nurses, pharmacists and social workers.
These collaborative care models “shift from crisis-oriented care, where families don’t know what to expect, to more proactive, calmer care, where the caregiver is supported in helping their loved one,” says UCSF clinical psychologist Katherine Possin. She directs the Care Ecosystem program that is used by more than 50 health systems and community-based organizations across the United States.UCLA has a similar program, and in 2024, the U.S. Centers for Medicare & Medicaid Services started trialing a federal dementia care model, paying approved organizations for each enrolled Medicare patient.
The benefits of collaborative care programs and of approved Alzheimer’s therapies are clear from prior research. But it would be impractical and cost-prohibitive to directly compare these interventions in thousands of patients over decades, says Kelly Atkins, a former UCSF postdoc who now works as a clinical neuropsychologist at Monash University in Melbourne, Australia.
Instead, Atkins and colleagues used a mathematical model with a simulated population of 1,000 71-year-olds. Their average age and characteristics mirrored participants from a large, published trial of the Alzheimer’s drug lecanemab (brand name Leqembi). Subjects encountered one of three scenarios: 18 months of lecanemab, collaborative care or both. similar to climate models that estimate how different courses of action could affect the planet over time, the computer model predicted outcomes of each intervention across the patients’ life span, informed by national data on mortality rates and quality of life and costs associated with mild to severe dementia.
Relative to usual care, lecanemab extended patients’ lives by 0.17 years and delayed their entry into long-term care by 0.17 years. By comparison, collaborative programs did not extend life but gave patients an extra 0.34 years at home before transitioning into a nursing home. Adding the drug further delayed that transition by 0.16 years.
In the United States, about 1 million people with Alzheimer’s would qualify for lecanemab based on disease stage and other factors, whereas more than 6 million people with dementia would be eligible for dementia care, the authors estimate. The drug costs $26,500 a year, though patients’ actual costs will vary due to insurance coverage and other factors.
So when scaled to the U.S.population, compared to usual care, 18 months of collaborative care saved $300 billion health care dollars while lecanemab cost $39.5 billion. These figures estimate total savings and dementia-associated costs — including additional medical procedures and nursing home care — over the remaining lifetime, if everyone who was eligible in 2024 received the interventions, Atkins says.
“It makes perfect sense,” says Josh Helman, a physician in south Florida who focuses on diet, exercise and lifestyle measures to prevent and treat Alzheimer’s. Putting resources into coordinating care for dementia patients can save health care dollars long-term “as opposed to waiting for side effects later on or having to pay for expensive memory care,” says Helman, who was not involved with the study.
Other experts caution against extrapolating from computer simulations. Data with real people should be collected prospectively — moving forward from a specific point in time — “to sort out whether that model leads to benefits for patients and their families,” says daniel Press, a neurologist at Beth Israel Deaconess Medical Center in Boston.
As health care systems navigate complexities of delivering the new Alzheimer’s drugs, the UCSF researchers hope their study shows the importance of dementia care reform. “Let’s face it,dementia [care] is not the part where the health system is making a lot of money,” Possin says. “It’s hard to get the business folks in medicine to pay attention to making changes and improvements.”