It is easy to lose track of other major public health concerns while the news covers the ongoing threat posed by COVID-19. Yet the list of other health threats is extensive: opioid abuse, obesity, heart disease and cancer among them. The personal and societal toll of Alzheimer’s and dementia certainly requires our attention. The number of older Americans is destined to rapidly grow in this country. So will the number of new and existing cases of Alzheimer’s.
Just consider the following facts provided by the Alzheimer’s Association: More than six million Americans are living with Alzheimer’s today. This number is projected to rise to nearly 13 million by 2050. During the COVID-19 pandemic, the United States saw Alzheimer’s and dementia deaths increase by 16%.
This year alone, the Alzheimer’s Association estimates that dealing with Alzheimer’s and other dementias will cost the nation $355 billion. By 2050, these costs could rise as high as $1.1 trillion. This is why we find ourselves so desperate for a treatment to arrest the disease while clinging to the hope that science will find a cure.
Now, a newly approved drug to treat Alzheimer’s disease enters the equation — Aduhelm. Questions of its approval and effectiveness aside, let’s just look at the consumer costs associated with it. While there are many drugs that cost more than Aduhelm, what makes it different is the millions of potential customers for it and the fact that it is designed to be taken for years.
As reported by Josh Katz, Sarah Kliff and Margot Sanger-Katz of the New York Times, “Aduhelm is not just expensive, but also somewhat hard to take, requiring monthly in-person visits to an infusion center for treatment. Patients who take it will be required to get multiple brain scans during their treatments to look for side effects.”
The annual projected cost for the treatment is said to be $56,000. According to an analysis published in the Beckers Hospital Review, the cost for many patients will likely be more. According to an analysis published July 9 in Health Affairs, “Medicare and other insurers will likely wind up paying between $61,000 and $62,000 for the drug.”
Aduhelm is an infused drug administered based on a patient’s weight. The Review says, quoting The Wall Street Journal: “Biogen’s based Aduhelm’s $56,000 annual list price on the three vials required to treat a patient who weighs 163 pounds” because 163 pounds is the average weight of Alzheimer’s patients in the U.S. who have the symptoms Aduhelm is meant to treat. For patients weighing 200 pounds, for example, the annual price rises to $68,430.
According to the report, Peter Bach, director of New York City-based Memorial Sloan Kettering Cancer Center’s drug pricing lab, analyzed how much the drug will cost after accounting for how it is packaged and administered. According to Dr. Bach’s analysis: “If 500,000 patients receive full doses of Aduhelm for a year, the amount of excess discarded drug would result in an additional $2 billion in annual revenue for Biogen.” Biogen, the maker of Aduhelm, has disputed this wastage estimate.
Regardless of the controversy surrounding this new drug, demand is expected to be high. The Alzheimer’s Association reports that one in nine people 65 and older has Alzheimer’s dementia. There are few medical treatment options for patients hoping to forestall cognitive decline from Alzheimer’s and other dementias.
“There is something intrinsically hard about having a loved one, seeing the clock ticking, and saying, Well, let’s just wait,” Dr. Steven Pearson, a primary care physician and the president of the Institute for Clinical and Economic Review explains to the Times. “It’s very hard to ignore the drive to do something.”
And something must be done.
According to the Alzheimer’s Association, more than 11 million Americans provide unpaid care for people with Alzheimer’s or other dementias. In 2020, the dollar value of such services was estimated to be at nearly $257 billion.
The current debate about this new drug has also overshadowed recent progress in understanding and potentially pre-empting Alzheimer’s onset.
Poor sleep duration has long thought to be associated with Alzheimer’s disease, though for years the cause-and-effect association has been hard to establish. Time magazine’s Jeffrey Kluger reports: “In a robust study published in April in Nature Communications, a sample group of 7,959 people had their health and sleep patterns tracked throughout their 50s, 60s and 70s. The results were striking: those who slept six hours or less per night had a 30% higher risk of developing dementia than those who slept seven hours.” Researchers speculate that “lack of sufficient sleep can be associated with neuroinflammation, atherosclerosis and poor clearance of amyloid protein — which makes up Alzheimer’s plaques — from the body.”
The human microbiome has a profound effect on overall health. Now, a study led by researchers at the Istituto Centro San Giovanni di Dio Fatebenefratelli in Italy has found further evidence to suggest that the trillions of bacteria and other microorganisms that live in the gut play a role in Alzheimer’s disease. “The findings point to the possibility of microbiota manipulation as a preventive for Alzheimer’s,” they report.
Over the past 30 years, researchers in age-related cognitive decline have generally analyzed data from men and women collectively. That has now changed. According to the New York Times, a current study is now exploring the ways menopause changes a women’s brain. They believe it may provide a crucial tool in establishing a treatment for Alzheimer’s. Janine Austin Clayton, director of the Office of Research on Women’s Health at the National Institutes of Health, says: “Men and women both undergo chronological aging and reproductive aging, but in distinct ways. Not looking at those separately masks findings and is a missed opportunity.”
As Pauline Maki, a professor of psychiatry, psychology and obstetrics & gynecology at the University of Illinois at Chicago College of Medicine, also reminds us, there are non-medical preventive measures people can take to protect cognitive health. She recommends “abstaining from tobacco, being physically active, eating a plant-rich diet, reducing stress and getting enough sleep — these are all ways to support brain function.”