Pay billions for controversial Alzheimer’s drug? How about some funding instead? | lifestyle

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If you could invest $ 56 billion every year improving health care for the elderly, how would you spend it? On an enormously expensive drug with questionable effectiveness – or something else?

This is not an abstract question. Aduhelm, a new Alzheimer’s drug approved by the Food and Drug Administration last month, could prescribe 1 to 2 million patients a year even using conservative criteria, according to Biogen and Eisai, the companies behind the drug.

The total annual price would be $ 56 billion if the average list price of $ 56,000 were put at the lower end of the companies’ estimate.

That’s a huge sum in all respects – more than the National Institutes of Health’s annual budget (nearly $ 43 billion this year). However, there is considerable uncertainty about the clinical benefits of Aduhelm, leading to controversy over its approval. The FDA has confirmed that it is not clear whether the drug actually slows the progression of Alzheimer’s disease, or by how much.

“This drug raises all sorts of questions about how we think about health and our priorities,” said Dr. Kenneth Covinsky, geriatrician and professor of medicine at the University of California-San Francisco.

Since most Alzheimer’s patients are older and on Medicare, the medication would place a significant financial burden on the federal government and beneficiaries. Several experts warn that spending on aducanumab, marketed as Aduhelm, could drive up Medicare Part B and Medicare top-up premiums and expenses.

A likely additional cost: missed opportunities to invest in other care improvements for older adults. When Medicare and Medicaid have to absorb drug spending on this scale, less attention is paid to other priorities.

I asked a dozen experts – geriatrists, economists, health policymakers – how they would spend an additional $ 56 billion annually. Their answers point to significant gaps in care for older adults. Here is some of what they suggested.

– Make Medicare More Affordable. High expenses are a growing burden on older adults and keep many from going to seek help, and Dr. David Himmelstein, a distinguished professor of urban public health at Hunter College in New York City, said additional funding will help reduce these costs. “I would cut Medicare co-payments and deductibles. I think that would go a long way in improving access to care and health outcomes, ”he said.

On average, older adults on Medicare spent $ 5,801 on health care in 2017 – 36% of the average annual social security benefit of $ 16,104, according to a report by AARP last year. By 2030, out-of-pocket healthcare spending could account for 50% of average social security benefits, KFF forecast in 2018.

– Pay for eye, hearing and dental care. Millions of older adults cannot afford hearing, visual and dental care – services that traditional Medicare does not cover. As a result, their quality of life is often negatively impacted and they are at increased risk of cognitive decline, social isolation, falls, infections, and depression.

“I would use the money to pay for these additional benefits that have proven hugely popular with Medicare Advantage members,” said Mark Pauly, professor of health management at the University of Pennsylvania’s Wharton School of Business. (Private Medicare Advantage plans, which cover approximately 24 million people, usually provide some type of hearing, vision, and dental benefits.)

Over a 10-year period (2020 to 2029), the cost of expanding Medicare to include comprehensive hearing, vision, and dental services would amount to $ 358 billion, according to the Congressional Budget Office.

– Support family carers. Nearly 42 million people provide help with shopping, cooking, paying bills, and physical care to the elderly trying to grow old at home. However, these unpaid caregivers receive little practical support.

Dr. Sharon Inouye, a geriatrician and professor of medicine at Harvard Medical School, suggests investing in paid home services to relieve unpaid caregivers, especially those who care for people with dementia. It would fund more short-term care programs that allow carers to take short-term breaks, as well as adult day centers where older adults can socialize and participate in activities. It also recommends devoting significant resources to expanding nursing training and support and providing nursing scholarships to reduce the financial impact of nursing. In most cases, Medicare does not cover these services.

“Providing this support could change people’s lives tremendously,” Inouye said.

– Strengthen long-term care. The shortage of direct caregivers – carers who look after older adults at home and in assisted living facilities, nursing homes, residential facilities, and other facilities – is a growing problem exacerbated by the coronavirus pandemic. PHI, a research organization studying direct care workforce, has estimated that as the baby boomers age, millions of direct care jobs will need to be filled.

“We could significantly improve long-term care staff by paying them better and better training them,” said Dr. Joanne Lynn, geriatrician and policy analyst at Altarum, a research and advisory organization.

– Help people age on the spot. Most older adults want to age on the spot, but many need support over time, surveys show. Will they be able to go up the stairs? Cooking on my own? To make the laundry? Take a shower?

Simple solutions can help, including relatively inexpensive home renovations (e.g. installing handrails on stairs, bathroom grab bars, and better lighting) and aids such as raised toilet seats, shower stools, or scooters. But Medicare doesn’t pay for renovations or certain helpful equipment.

UCSF’s Covinsky would make a program called CAPABLE (Community Aging In Place – Advancing Better Living for Elders) a Medicare benefit, available to all 61 million members. This program combines home visits from an occupational therapist and registered nurse, typically over 10 weeks, with up to $ 1,300 in services from a handyman.

The evidence shows that it has a significant positive impact in helping seniors do daily activities and stay away from nursing homes. The total cost: $ 3,000 per person. “With less than one infusion of aducanumab, you can vastly improve a person’s quality of life and well-being,” said Covinsky.

– Find out what older adults need. Sarah Szanton, director of the Center for Innovative Care in Aging at the Johns Hopkins School of Nursing, developed CAPABLE. She would use $ 56 billion to evaluate each older adult each year “to find out what they need to live comfortably and independently. From this I made a list of tailored interventions ”- specific action points that CAPABLE or other programs could include, she told me.

Initiatives that could use additional funding could focus on treating depression, preventing falls, or structuring activities for people with dementia, Szanton said.

– focus on prevention. A growing body of evidence suggests that if people don’t drink excessively, control blood pressure and obesity, manage depression, use hearing aids, and quit smoking, dementia could be prevented – perhaps up to 40% of the time – regularly involved in sports, social interactions and cognitively stimulating activities, among other things.

“If I had $ 56 billion I would focus on prevention,” said Laura Gitlin, dementia expert and dean of Drexel University’s College of Nursing and Health Professions.

“Right now there is more evidence for these strategies than for Aduhelm,” said Dr. David Reuben, UCLA director of geriatrics and director of the Alzheimer’s and dementia treatment program.

– Invest in social determinants of health. The health of older adults is shaped by the environment in which they live, how they interact with other people, and the simple satisfaction of basic needs.

In recognition of this, Dr. Anthony Joseph Viera, professor of family medicine and community health at Duke University School of Medicine, said he will invest in “transportation for the elderly”. Safe living. Eat. Programs that reduce social isolation. In the end, these would help a lot more people. “

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(KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health topics. Along with Policy Analysis and Polling, KHN is one of the three major operational programs of the KFF (Kaiser Family Foundation). KFF is a not-for-profit organization that provides health information to the nation.)

© 2021 Kaiser Health News. Distributed by Tribune Content Agency, LLC.