(B-177) Effect of Antihypertensive Medications on Economic Burden Among Alzheimer’s Disease and Related Dementia Medicaid Beneficiaries in South Carolina

Background: In South Carolina (SC), Alzheimer’s disease and related dementias (ADRD) are major public health concerns and could cause a heavy economic burden. Taking antihypertensive medications (AHMs) may help delay the progression of dementia, however, the economic burden and related racial/ethnic disparities were unknown.

Objectives: This study aimed to examine the association between AHMs use and the economic burden among ADRD patients in SC, as well as racial/ethnic disparities, utilizing SC Medicaid data linked to the SC Alzheimer’s disease (AD) Registry.

Methods: A cross-sectional study was performed using SC Medicaid data linked with the SC AD Registry, the nation's oldest and most extensive statewide ADRD diagnosis database. The registry collects demographic and diagnostic data to estimate ADRD prevalence statewide and can be linked with various health and social datasets with proper authorization. This study used data from the SC AD Registry covering 2005 to 2021 to identify ADRD patients. AHMs usage was identified through Medicaid "Pharmacy Files," including all FDA-approved AHMs except aliskiren due to data limitations. The outcomes analyzed were annual inpatient, outpatient, emergency room, and drug costs, all converted to 2024 US$. The study population was ADRD individuals aged 65 and older. Generalized regression with a gamma distribution and log link was used to assess the relationship between AHMs use and economic burden among ADRD patients, as well as racial/ethnic disparities, adjusting for age, sex, residence, and marital status.

Results: A total of 7,865 Medicaid beneficiaries with ADRD were included in the study, with 61.16% of them taking AHMs. Taking AHMs was related to 30.94%, 31.81%, 24.41%, and 224.12% more inpatient costs, outpatient costs, emergency room costs, and drug costs, respectively (P < 0.05). Compared to non-Hispanic (NH) White ADRD patients, NH Blacks, Hispanics, and other races/ethnicities were more likely to have higher inpatient costs, outpatient costs, and emergency room costs (P < 0.05). Additionally, NH Black patients had 11.74% lower drug costs compared with their white counterparts (P = 0.002).

Conclusions: This study revealed that the use of AHMs was associated with an increased economic burden in the SC Medicaid population with ADRD. Additionally, racial/ethnic disparities in healthcare costs were evident, with minority groups facing a greater economic burden. While AHMs may help slow the progression of ADRD, the additional costs need to be addressed. Balancing the potential benefits of AHMs with the financial impact on ADRD patients is crucial, especially in racial/ethnic minority populations, to ensure equitable access to treatment and care.