Our brain is an extraordinary organ. This three-pound structure is the central processing unit of our universe that controls intelligence, sense, movement, behavior and much more. When healthy, we take it for granted, and when diseased we carry a substantial burden.
Astonishingly, the burden of Alzheimer’s disease (AD) and related dementias is growing rapidly with an aging population. The economic and health burden is expected to reach nearly $1 trillion by 2050. This is a massive amount, especially when considering it as a percentage of gross domestic product (GDP), which can range from 2% to 5%.
Imagine if we could solve this problem; what it would mean for you, and what would it mean for society as a whole? How much are you willing to spend to save your brain?
I distinctly recall the day my grandfather looked at me and couldn’t remember my name, and the role reversal that started when we received his Alzheimer’s diagnosis. As the disease progresses, the growing cost for care is a tremendous concern for patients and caregivers.
AD is the fifth-leading cause of death in adults older than 65; approximately 6 million people in the U.S. are living with AD, and it’s estimated to increase to 13 million by 2050. My team and I suspect this number would be much higher if there was a reason for people to get diagnosed – such as having a safe, easy, efficacious treatment available. Despite recent advances in treatments, the economic burdens overshadow any progress in research and development once we begin to unpack the cost of care.
The direct and indirect costs of care for AD are monumental, from treatment and medical equipment to home safety modifications, prescription drugs and care supplies. In 2023 alone, the estimated healthcare costs associated with AD are projected to reach $345 billion.
With an anticipated dramatic rise of Americans diagnosed with AD approaching, broad changes to Medicare are needed. While Medicare and other sources of financial assistance may cover some of these costs, they won’t cover it all, leaving individuals with AD or other dementias and their families with high out-of-pocket costs.
On average, Medicare beneficiaries aged 65+ with AD or other dementias paid $10,241 out-of-pocket annually for healthcare and long-term care services not covered by other sources. Yearly costs add up, leading to a total lifetime cost of care of around $392,874 in 2022. The same report noted that 70% of the lifetime cost of care is borne by family caregivers in the forms of unpaid caregiving and out-of-pocket expenses ranging from medications and food. And these are just the monetary costs. The economic burden of AD also impacts mental health and productivity.
We’re still waiting for a treatment that prevents or stops the decline of AD. Meantime, there are current therapies approaching the FDA approval process, but they come at a high cost and don’t stop cognitive degeneration, but instead only extend life by several months. With a price averaging $26,500 per year for therapy, the number of patients who will be able to access the new treatments at that cost will be limited.
Although these anticipated treatment approvals have introduced a beacon of hope, the excitement has been tempered by the announcement that it will only be covered by Medicare exclusively for patients enrolled in approved clinical trials. Unfortunately, new treatments will not relieve the burden of cost for families and caregivers, which is often unaccounted for in projections.
There are a myriad of hidden costs associated with current AD treatments which haven’t been broadly discussed, such as healthcare personnel to administer the drugs, the development of new infusion and MRI centers, and clinicians to maintain the continuum of care for these patients.
I believe the keys to reducing health and long-term care costs associated with AD include earlier diagnosis, healthcare and insurance providers working together, and the approval of a therapy that changes the course of the disease – one that blocks the development of AD rather than delaying disease progression. This requires broadening our approach to treating AD and related brain diseases, which ultimately requires additional government and private support to fund novel approaches.
The potential cost savings of early diagnosis is projected to be around $7 trillion. It’s estimated that a treatment slowing the rate of functional decline by 10% would reduce total average per-person lifetime costs by $4,737. The potential savings from treatment or an earlier diagnosis may depend on structural changes to the healthcare system. The AD industry and insurance providers must work together to address the enormous costs patients and their families face.
Although the AD industry is progressing, the advancements are diminished due to the extreme financial burden that is crippling families into debt instead of alleviating the strain. As time goes on, I remain hopeful that my children will not have to experience the two deaths of AD, death of the body and soul, as I did with my grandfather. The current treatment landscape means only those who can pay out of pocket have access to “delay the inevitable” until a cheaper, more perfect drug is produced and made easily attainable for the millions of AD patients.
Looking ahead, the AD industry needs to shift away from the groupthink mentality and embrace innovative new treatment approaches that go beyond targeting amyloid to delay disease progression. The industry should focus on novel, promising therapies that stop the disease in its tracks, such as chemotherapeutics and immunotherapies that can extend life by two years. I have experienced the effectiveness of these life-changing therapies and believe in giving patients access to the best available treatments.
AD patients, caregivers and their families deserve better therapies and financial support. Through the promotion of disease awareness, early diagnosis, and treatment and disease management programs focused on care coordination and caregiver support, we have the opportunity to mitigate costs, and positively impact outcomes for AD patients and their loved ones in the future.
About David Moss
David Moss has been Chief Financial Officer and Co-Founder of INmune Bio since the formation of the Company in September 2015 where he is passionate about solving brain diseases through novel therapeutic approaches. His company, INmune Bio, is focused on modulating components of the innate immune system to activate an immune response against cancer and Alzheimer’s disease.