Effectiveness and Cost-effectiveness in Alzheimer’s Treatment - Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD) are common and increasing across the world. Black and low-income populations have an even higher risk of AD/ADRD than other populations, but despite this higher risk these populations have been less studied. Recently, new anti-amyloid medications have demonstrated impressive amyloid clearance from the brain and improvements in key dementia outcomes. However, significant adverse events have been demonstrated in all trials. Further, diagnostic, monitoring, delivery, transportation, and financial burdens also exist and may be particularly problematic for Black and low-income populations. Therefore, there is a critical need to better understand the effectiveness and cost-effectiveness of anti-amyloid medications in Black, low-income populations. In the R61 Planning Phase, we will engage stakeholders and establish the theoretical framework to conduct the remaining analyses. Specifically, during Aim 1, we will use a mixed methods approach to better understand the preferences and factors affecting real-world effectiveness and cost-effectiveness in Flint, Michigan (predominantly Black and/or low-income). Qualitative interviews and quantitative surveys will be performed in those with mild cognitive impairment and AD with a focus on diagnostic, monitoring, delivery, transportation, and financial burden (out-of-pocket costs). During Aim 2, we will determine utilization, costs, adherence, and real-world adverse event rates of anti-amyloid medication in Black, low-income populations using healthcare claims datasets representing those with Medicare, Medicaid, and Veterans. Finally, in Aim 3, we will determine the effectiveness and cost-effectiveness of anti-amyloid medications in Black, low-income populations by using the information obtained in Aims 1 and 2. Monte Carlo simulation methods will be used to estimate outcomes in a simulated population derived from data on AD incidence and mortality. The proposed aims will improve our understanding of the effectiveness and cost-effectiveness of the new anti-amyloid medications in Black, low-income populations. This information has the potential to lead to interventions to improve cost-effectiveness, which could focus on improving effectiveness and/or reducing costs. We will also have the ability to determine whether healthcare disparities exist by comparing utilization between Black, low-income populations to other populations.
