Project Summary/abstract
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.