(A-152) Costs and Lost Time for Employees whose Spouses have Dementia and/or Alzheimer’s Disease and Patient Direct Costs

Background: In the US, nearly 7m people are living with Alzheimer's disease (AD), the most common cause of dementia (DEM). >11m Americans provide unpaid care for people with AD or DEM, estimated as 8.4b hours and ~$350b in 2023. Some unpaid care comes from spouses who are caregivers (CGs) using Discretionary Incidental Time-off (DITO) and Family Medical Leaves (FMLs) for care of a spouse patient (pt). CGs health and costs and absences are impacted after becoming a CG.

Objectives: Examine annual changes in caregiver absences CGs and direct pt+CG (Medical, Rx, and Total) costs.

Methods: Retrospective analysis of the Workpartners Research Reference Database (RRDb,2018—2022) of pts with ICD codes for DEM, AD, or both (D-AD). Pts & CGs had >1 year of continuous data following pts initial Dx and analyzed by year of the initial Dx (IndexYear). The following outcomes were reported based on the condition and IndexYear: CG FML claims filed, DITO and FML days / year; Per Member Per Month (MPM) MED$, Rx$ and total (TOT$) direct (CGs, pts). The % and trends of pts PMPM MED$, RX$, and TOT$ were also examined.

Results: We identified 2851 CG-pt pairs: AD=23.8%, DEM=79.2%, and 10.2% were diagnosed with both (D-AD). From 2018 to 2022 AD pairs ↑ 1.9x, DEM and D-AD ↑>2x. 43-46% of pts were female, and averaged 62.6y=AD, 55.1y=DEM, 55.3y=D-AD. CGs filed FML claims for pts with AD=14%, DEM=10%, D-AD=12%. DITO days for DEM ↑ (mean 23.2→26.2 days, median 18→25 days); D-AD (mean 26.4→29.3 days, median 21→25.5 days) and ↓ slightly for AD (mean 43.1→42.2 days, median 39→38.5 days). Mean AD MED$ ↓ from $3666→2017 for pts and ↑ for CGs $1048→$2094; Rx$ ↓ for both (pts: $311→219, CGs: $710→323); TOT$ for pts ↓ from $3976→2236 and ↑ from $1758→2417 for CGs. Pts averaged 70.9% of MED$ (↓ from 77.8→49.1%), 41% of Rx$ (↑ from 30.5—40.4%), and 65.7% of TOT$ (↓ from 69.3—40.3%) costs. Mean DEM MED$ ↓ from $2884→1636 for pts and CGs $953→$595; Rx$ ↑ from $491→692 (pts) and $168→640 (CGs), TOT$ for pts ↓ from $3376→$2328 and CGs ↑ from $1122→1236. Pts averaged 74.6% of MED$ (ranging from 71.2—76.8%), 64.1% of Rx$ (↓ from 74.5→52%), and 71.2% of TOT$ (↓ from 75.1→67.4%). Mean D-AD MED$ ↓ from $2711→1505 (pts), $1011→850 (CGs); Rx$ ↑ from $465→649 for pts and from $299→594 for CGs; TOT$ for pts ↑ from $3176→2206, and ↑ from $1310→1444 for CGs. Pts averaged 72.2% of MED$ (↓ from 72.8—64.7%), 60.2% of Rx$ (↓ from 60.9—52.2%), and TOT$ ↓ from 70.8—60.3%.

Conclusions: As the diagnosis age for Alzheimer's disease and dementia continues to decrease, more employees will assume caregiving roles and may require time off to help manage their affected partners. Employers need to understand changes in medical and prescription costs for their covered lives (patients and caregivers) and the impact of these conditions on employee work absences.