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Increase in healthcare utilization and Medicare payment with progression of preclinical Alzheimer's disease
Beyrer J, Sheff Z, Payakachat N, Chandler JM, Chen YF, Kubisiak J, Lee A, Holdridge KC, Yaari R, Aisen P, Rafii MS, Sperling RA, et al.. Journal of Prevention of Alzheimer's Disease, 2026-04-01
Topic: Amyloid, tau and blood-test diagnosis
Results HRU and payments were overall similar between A4 and LEARN Medicare. Claims indicators suggesting AD progression in A4 Medicare were associated with higher inpatient, outpatient, emergency room, and home health utilization (any utilization) and increased number of inpatient stays. Payments were significantly greater in A4 Medicare with AD progression vs without progression: 45% payment increase for cognitive impairment (p=0.035) with a mean incremental cost of $140 per person per month (PPPM) (95% confidence interval [CI] $125-$155), 66% payment increase for AD (p=0.011) with a mean incremental cost of $207 PPPM (95% CI $188-$226), and 103% payment increase for high frailty (p Conclusions Overall, individuals with cognitively unimpaired AD in A4 Medicare did not have increased utilization and payments vs LEARN. HRU and payments were significantly greater in A4 Medicare participants with AD progression indicators in claims vs those without progression. These results highlight the need for additional research on both health and economic impacts of progression in a real-world (routine care) cohort of individuals with cognitively unimpaired AD and the potential cost savings associated with effective therapy that delays AD progression in cognitively unimpaired AD.
Key findings
- Results HRU and payments were overall similar between A4 and LEARN Medicare.
- Claims indicators suggesting AD progression in A4 Medicare were associated with higher inpatient, outpatient, emergency room, and home health utilization (any utilization) and increased number of inpatient stays.
- Payments were significantly greater in A4 Medicare with AD progression vs without progression: 45% payment increase for cognitive impairment (p=0.035) with a mean incremental cost of $140 per person per month (PPPM) (95% confidence interval [CI] $125-$155), 66% payment increase for AD (p=0.011) with a mean incremental cost of $207 PPPM (95% CI $188-$226), and 103% payment increase for high frailty (p<0.001) with a mean incremental cost of $303 PPPM (95% CI $283-$323).
- HRU and payments were significantly greater in A4 Medicare participants with AD progression indicators in claims vs those without progression.
- These results highlight the need for additional research on both health and economic impacts of progression in a real-world (routine care) cohort of individuals with cognitively unimpaired AD and the potential cost savings associated with effective therapy that delays AD progression in cognitively unimpaired AD.
Why it matters
In this cohort study, individuals with cognitively unimpaired Alzheimer's disease in the A4 Medicare group did not have increased healthcare utilization and payments compared with the LEARN group overall, but those with claims indicators of Alzheimer's disease progression had significantly greater utilization and payments. The authors state that additional research is needed on the health and economic impacts of progression and the potential cost savings associated with effective therapy that delays progression.
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Study details
- Study designcohort
- Participants367
- Effect sizeMedicare payments 45% higher with cognitive-impairment codes ($140 PPPM), 66% with AD codes ($207 PPPM), 103% with high frailty ($303 PPPM)
- Evidence strengthEarly
Limitations
Small sample (246 A4 and 121 LEARN participants), limiting assessment of heterogeneity; analysis covered only the pre-study and on-study periods, so long-term cost inferences are unreliable; participants were predominantly White; and findings may generalise better to people who seek trial evaluation than to the broader population with preclinical AD.
How this study scored 50/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it. We have no data on free to read, so that was left out: it earned 49 of the 98 points we could judge it on, which is 50 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Prevention of Alzheimer's Disease) |
| Journal's citation record | 0 / 4 | The Journal of Prevention of Alzheimer s Disease: journal h-index 63 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 2 / 5 | Rated “early” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 367 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Reisa Anne Sperling: h-index 157 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41926844) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 49 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 49 of the 98 points we could judge it on is 50 out of 100. |
| Total | 50 / 100 | — |
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Read the original
- DOI: 10.1016/j.tjpad.2026.100547
- PubMed: 41926844
- Original source →
- Free full text: PubMed Central →
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Beyrer, J., Sheff, Z., Payakachat, N., Chandler, J. M., Chen, Y. F., Kubisiak, J., et al. (2026). Increase in healthcare utilization and Medicare payment with progression of preclinical Alzheimer's disease. Journal of Prevention of Alzheimer's Disease. https://doi.org/10.1016/j.tjpad.2026.100547
Vancouver
Beyrer J, Sheff Z, Payakachat N, Chandler JM, Chen YF, Kubisiak J, et al. Increase in healthcare utilization and Medicare payment with progression of preclinical Alzheimer's disease. Journal of Prevention of Alzheimer's Disease. 2026. doi:10.1016/j.tjpad.2026.100547. PMID: 41926844.
BibTeX
@article{beyrer2026-41926844,
author = {Beyrer, J. and Sheff, Z. and Payakachat, N. and Chandler, J. M. and Chen, Y. F. and Kubisiak, J. and Lee, A. and Holdridge, K. C. and Yaari, R. and Aisen, P. and Rafii, M. S. and Sperling, R. A. and others},
title = {{Increase in healthcare utilization and Medicare payment with progression of preclinical Alzheimer's disease}},
journal = {Journal of Prevention of Alzheimer's Disease},
year = {2026},
doi = {10.1016/j.tjpad.2026.100547},
pmid = {41926844},
url = {https://doi.org/10.1016/j.tjpad.2026.100547}
}
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