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Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

Senate Appropriations Panel Examines Alzheimer’s Disease Costs and Current Research Efforts

February 28, 2014—The Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies Feb. 26 held a hearing on the rising economic cost of Alzheimer’s disease and the state of research into its prevention and cure.

Committee Chair Tom Harkin (D-Iowa) began the hearing by noting, “We now spend approximately half a billion dollars each year on research into Alzheimer's disease. We've had some successes along the way, but the harsh reality is that we still do not know how to prevent, reverse, or definitively diagnose Alzheimer's disease.”  He added, “More research is desperately and urgently needed.”

Senator Jerry Moran (R-Kan.), the ranking member of the subcommittee, said, “Alzheimer's disease has become a disease to define a generation, but if we focus our priorities on our research capacity, it does not need to continue to be an inevitable part of the aging process.” He noted, “For every $27 that Medicare and Medicaid spend caring for individuals with Alzheimer's, the federal government only spends $1 on Alzheimer's research…. [W]ithout a way to prevent, cure, or effectively treat Alzheimer's, it will be difficult, if not impossible, to rein in our nation's health care costs.”

National Institutes of Health (NIH) Director Francis Collins, M.D., Ph.D., began his testimony by thanking the subcommittee for the recent FY 2014 Omnibus Appropriation for NIH, saying, “While difficult trade-offs did not ultimately make it possible in FY 2014 to completely reverse the devastating effects of the FY 2013 sequester, we are gratified that NIH was able to turn that corner.”

Dr. Collins said the $100 million increase the subcommittee provided in FY 2014 for research on diseases of aging would allow NIH “to make major investments in four cutting edge areas of dementia research that we would otherwise not have been able to pursue: genetic analysis, optogenetics, stem cells and translational centers.”

Dr. Collins described current efforts to identify and validate biomarkers, which he said “should improve our ability to diagnose and hopefully treat Alzheimer’s at a much earlier stage, before so many brain cells have been lost.” He told the subcommittee, “It may also be possible to use these scans or other biochemical measures in blood or spinal fluid to see if a new therapy is working even before [the disease] has an impact on the course of memory loss.”

Dr. Collins also described the recently announced Accelerating Medicines Partnership (AMP), which he said “is an unprecedented collaboration between NIH and 10 pharmaceutical firms and will accelerate identification and testing of drug targets for Alzheimer's disease, diabetes, rheumatoid arthritis, and lupus.”  He said that $230 million will be invested over five years with NIH and industry contributing equally.

Responding to a question from Chairman Harkin on research into what people can do to reduce the risk of Alzheimer’s, National Institutes of Aging (NIA) Director Richard Hodes, M.D., explained there are studies looking at the effect of exercise intervention and its impact on the ability to maintain mobility and cognitive function. He also cited two studies at the University of Kansas that are looking at either presymptomatic or early symptomatic disease to determine whether exercise actually changes the course of the disease or changes the brain alterations that have been observed.

Chairman Harkin also asked what NIH is doing to encourage more participation by minorities in research efforts directed at Alzheimer’s.  Dr. Hodes said, “We are indeed making great efforts to correct what you point out, an underrepresentation of minorities in clinical studies, in particular clinical trials.” He noted that all the Alzheimer's disease research centers have outreach cores, and some, such as in Chicago, serve an area where some 90 percent of individuals are African-American.

Full committee chair Barbara Mikulski (D-Md.) asked Dr. Collins, “[I]s it that we need more money? Do we need more people going into science? What do we need to put this on the fast track…?”  Dr. Collins replied, “I think we are not at the moment limited by ideas. We're not limited by scientific opportunities. We're not limited by talent. We are unfortunately limited by resources to be able to move this enterprise forward at the pace that it could take.”

Story Landis, Ph.D., director, National Institute of Neurological Disorders and Stroke, described the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative, which she co-leads.  She said BRAIN will bring together neuroscientists, computational researchers, physicists, chemists, engineers to develop tools that then can be applied to answer questions about how brain circuits function, adding, “[T]hat obviously starts with normal brain circuits but what we learn from understanding normal brain function will have significant implications for diseases like Alzheimer's, other kinds of dementia, Parkinson's disease and epilepsy.”

Michael Hurd, Ph.D., director, RAND Center for the Study of Aging, and senior principal researcher and professor, Pardee RAND Graduate School, testified on research conducted by RAND and the University of Michigan published last April on the monetary costs of dementia. He said that in 2010 the prevalence of dementia in the population aged 71 or older was 14.7 percent and the annual health care spending attributable to dementia was about $29,000 dollars person.  He explained that adding in the cost of unpaid or informal care increased the total annual cost per person to between $42,000 and $56,000.

Dr. Hurd testified that using census estimates of the population to estimate the annual cost of dementia in the United States, they found that actual spending attributable to dementia was $109 billion dollars in 2010, which makes dementia the most costly disease in the United States in terms of actual spending. Adding in costs for informal care increased this estimate to a range of $160 billion to $250 billion per year.

Because the prevalence of dementia sharply increases with age, Dr. Hurd explained the aging of the population itself, particularly when the baby boom generation reaches an advanced stage, will increase future costs. He said the costs for care purchased in the marketplace will increase in real terms from the 2010 value of $109 billion dollars to $260 billion dollars in 2040. Adding in the costs of informal care increases the cost estimate to the range of $380 billion to $510 billion dollars per year in 2040.

Former Congressman Dennis Moore (R-Kan.), who announced his diagnosis of Alzheimer’s disease in 2012, and actor Seth Rogen, whose mother-in-law has the disease, also testified on their experiences.

Contact:

Dave Moore
Senior Director, Government Relations
Telephone: 202-828-0559
Email: dbmoore@aamc.org

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org