Evaluating Pre-Treatment Patient Pathways in Early Alzheimer's Disease Management: A Claims Data Analysis in Germany

OBJECTIVES: In Germany, the prevalence of Alzheimer's disease (AD) is increasing due to an aging population. Timely diagnosis and effective treatment strategies are crucial in improving patient outcomes and resource allocation. This study aims to analyze patient pathways leading up to the first treatment for early AD (mild cognitive impairment due to AD and mild AD dementia) in Germany.

METHODS: A non-interventional retrospective analysis was conducted using claims data from the InGef research database for 2014-2022. The analysis cohort comprised individuals aged ≥50 identified through AChE inhibitor de-novo prescriptions of donepezil, galantamine, or rivastigmine in 2022 and without memantine prescriptions within a 100-day period. Outcomes were evaluated longitudinally in patient's individual pre-observation periods on a year-by-year basis focusing on AD diagnoses, prescriptions, and diagnostic procedures.

RESULTS: In total, 1,997 patients were identified with a mean age of 80.1 years and female patients comprising 56.5% of the cohort. Early AD was diagnosed in 0.9% of patients in year -8 compared to 20.5% in year -1 before first treatment in 2022. The highest increase in prescriptions was observed in psycholeptics, with +139.5% increasing from 7.9% of patients (year -8) to 18.8% of patients (year -1). Another prescription group among those with the highest increase were psychoanaleptics (14.8% (year -8) to 27.7% (year -1) (+87.2%)). Fluid diagnostics showed an increase from 1.2% patients in year -8 to 9.2% in the year -1. For advanced diagnostics, the highest proportion of patients in year -1 was seen in MRIs with 39.1% of patients followed by CTs with 28.6% of patients.

CONCLUSIONS: Understanding patient pathways can help identify potential areas for improvement in clinical practice, healthcare resource allocation, and patient care delivery. The findings of this study suggest a gap in the timely and guideline conform diagnosing and pharmacological management in early AD, indicating suboptimal care provision and resource utilization.