Merkin Brain and Health Policy Innovation Program 2013
Table of Contents Meet 2013 Fellow Daniella Meeker Research Spotlight on Alzheimer s Disease Meet 2013 Fellow Daniella Meeker 1 Research Spotlights: Alzheimer s Disease 1-2 Brain and Chid Development 4 Levitt Elected to the IOM 4 Upcoming Merkin Lecture Series 5 Daniella Meeker (Ph.D. Computation and Neural Systems, California Institute of Technology) is a Systems Engineer and an Information Scientist at RAND. Before joining RAND s research staff, she completed a post-doctoral fellowship at the RAND Bing Center for Health Economics. Her current research is focused on distributed architectures for data management, analysis, and translational practice. Her other work includes development of collaborative platforms for knowledge management, program evaluation, social network analysis, and applied health and behavioral economics. Dr. Meeker has served as the technical and implementation lead for two clinical data research networks funded by the National Institute on Aging and the Agency for Healthcare Research and Quality. Predictive models of quality of life trajectories for patients with Alzheimer s and dementia Daniella Meeker Growing attention has been placed on the epidemic of cognitive disorders such as Alzheimer s disease and Dementia. This epidemic is due in part to increased survival as conditions such as heart disease and cancer are increasingly well-treated and managed. The burden of cognitive disorders on caregivers and the health care system are high. Changing demographics of disease suggest that new policies must be developed in order to understand ways to prevent disease and how best to develop infrastructure to maintain quality of life among patients and caregivers. Understanding the timing and type of policies that are effective requires developing predictive modeling of disease progression, and identification of opportunities to intervene. Using data from the Health And Retirement Study, a longitudinal survey of Americans, 52 and older, coupled with Medicare claims data we carry out a trajectory analysis to identify clusters of disease progression, create predictive models, and characterize factors that contribute to better or worse than expected trajectories. Finally, we will forecast the impact on cost and quality of life of different interventions cited in the literature. These results will inform how policies for caregiver support, coverage for long term care services, and possibly early intervention and treatment can optimize the quality of life for patients and caregivers. 1
Research Spotlight on Alzheimer s Disease The Value of Delaying Alzheimer s Disease Onset Julie Zissimopoulos, Eileen Crimmins, Patricia St. Clair and Dana Goldman The steady rise in longevity over the past 50 years has tremendous social value but it comes at a cost. Over the same period of time, the United States has devoted an increasing share of its income to health care resulting in dire consequences for the long-term fiscal outlook of the U.S. There are myriad reasons why health care spending has risen including aging and population growth, insurance expansions, price changes, and new technologies. Providing accurate and timely assessment of current and forthcoming treatments for Alzheimer s Disease (AD) and policies related to the disease is particular relevant because of the high economic and social cost associated with AD. The need to address the economic and social costs of Alzheimer s disease increases in urgency as the baby boom generation ages and life expectancy continues its decades long increase. According to the U.S. Census, in 2012, there were 40.3 million Americans 65 and older, constituting 13% of the population. By 2050, there will be 88.5 million Americans aged 65 and older constituting 20% of the population, thus the number of Americans affected by AD is expected to rise dramatically. While there are no existing interventions proven to halt Alzheimer s disease and interventions designed to slow disease progression have had limited success, promising drug therapies have been identified. We use an economic and health simulation model to estimate current and future prevalence of AD and formal and informal costs of AD given current trends in demographics and health conditions. We estimate the effects of a hypothetical medical intervention that delays the onset of AD for 1, 3 and 5 years on the magnitude of the population with AD, costs of the disease and value of this treatment. Using nationally representative longitudinal data from the Health and Retirement Study and Aging, Demographics and Memory Study we found that from 2010 to 2050, the number of people ages 70 and older with AD will increase from 3.6 million to 9.1 million. Annual formal and informal costs of individuals aged 70 and older with AD are $321 billion in 2010 composed of $195 billion in formal costs and $126 billion in informal costs. By 2050, total costs rise to $1.6 trillion. In 2010, yearly per person total costs of individuals with AD were $75,000 and will almost double by 2050. About 75% of the costs are attributed to Medicare and Medicaid. A medical or pharmaceutical innovation that delays onset of AD for five years will result in an American population ages 70 and older with AD that is 41% lower in 2050 than the population would otherwise have been and societal costs that are 43% lower. Delaying AD by 5 years leads to 2.5 additional AD-free years of life for an individual who would have acquired AD and is worth about $475,000 to an individual net of the increase in formal and informal costs associated with a longer life....we found that from 2010 to 2050, the number of people ages 70 and older with Alzheimer s Disease will increase from 3.6 million to 9.1 million... 2 3
Levitt Elected to the Institute of Medicine Research Spotlight on Brain and Child Development Upcoming Merkin Lecture Series Pat Levitt Internationally recognized autism expert and Merkin Program co-director, Pat Levitt, PhD, of The Saban Research Institute of Children s Hospital Los Angeles, was recently elected as a member into the prestigious Institute of Medicine (IOM), part of the National Academy of Sciences. The IOM is an independent non-governmental organization that provides unbiased, expert advice to policy makers and the public. By election to the IOM, Levitt is recognized for his outstanding professional achievement and commitment to advancing the nation s health. This election is a great and very rare honor. It recognizes my career in research that, in some way, is viewed by my peers as impacting medicine and those who depend on scientific discovery to improve the lives of their children and families, says Levitt. The core story of brain and child development starts from a single vision - healthy development of young children provides a strong foundation for healthy and competent adulthood, responsible citizenship, economic productivity, strong communities and a just and fair society. During the past year, Dr. Levitt has participated in a number of health and education policy activities that address this core story, with the expected outcomes of 1) increasing state focus on at-risk populations for mental and physical health disorders and 2) public and private investment in programs that reduce risk and enhance developmental outcomes that impact life-long health outcomes. Knowledge transfer to policy makers, practitioners and business leaders included the following: Understand the specific core ingredients of development that contribute to the building of healthy brain architecture. Understand the power of genetics and experience positive or negative in impacting brain and child development. Understand how fundamental social, emotional and cognitive skills in children are established, and why these are interconnected. Understand the research that has shown social-emotional skill development as a core component of human capital formation. Understand the research that supports the findings that early adversity (termed toxic stress ) contributes to greater risk for long-term mental (e.g. substance abuse, depression, anxiety, defiance dis- Dr. Louis A. Vismara is an interventional cardiologist and a parent of four children. Since his son Mark was diagnosed with autism, he has dedicated himself to issues of child development, learning differences, diversity and access to health care for under-served populations. Lou was a co-founder of the UC Davis MIND Institute and currently serves as the chairperson of the MIND Advisory Board. Lou was also a founding member of the Proposition 10, First 5 California State Commission. Presently he is a member of multiple advisory organizations, including the UC Davis School of Education. In 2000 Dr. Vismara changed careers, retiring from his medical career to work as a full-time senior policy consultant for the California State Senate. Lou has worked on numerous health-related initiatives and was instrumental in the formation of the California Legislative Blue Ribbon Commission on Autism. Currently, Lou is a senior member of Sen. Darrell Steinberg s staff and also serves as the chief consultant to the Senate Select Committee on Autism & Related Disorders. Lou, who was born in Italy and immigrated with his family to San Diego as a child, is the recipient of a BA degree from Stanford University and an MD degree from Baylor College of Medicine. Prior to starting a cardiovascular group practice at Mercy General Hospital, Lou was a Cardiology Fellow and faculty member at the UC Davis Health System. Lou Vismara, M.D. Policy Consultant to President Pro Tem Darrell Steinberg of the California State Senate UC Davis, School of Education Seminar will be held on Tuesday, May 27, 2014 at the USC Schaeffer Center for Health Policy & Economics, 3335 S. Figueroa Ave, Unit A, Los Angeles, CA 90089 For the latest information about this and all events at the Schaeffer Center, like us on facebook at facebook.com/schaefferusc orders) and physical (e.g. cancer, diabetes, obesity, cardiovascular) health both short- and long-term. 4 5
About Dr. Richard Merkin: Richard Merkin, M.D. has been the Chief Executive Officer and founder of the Heritage Group since 1979. Under his stewardship, The Heritage Group has become the largest, physician-owned and operated integrated delivery system in the United States with over 50 related healthcare companies. The Heritage Group encompasses venture capital, private equity, and insurance companies. Dr. Merkin serves on the Board of Trustees for the California Institute of Technology and the Board of Overseers for the Keck School of Medicine of USC. He has established the Richard Merkin Foundation for Stem Cell Research at the Broad Institute at Harvard and the Massachusetts Institute of Technology, the Richard Merkin Initiative at the Johns Hopkins Brain Sciences Institute, and the Richard Merkin Foundation for Neural Regeneration at UCLA. He serves on the Board of Directors at the California NanoSystems Institute at UCLA. He is the Co-founder of Fastercures and founded the Heritage Medical Research Institute, a nonprofit medical research corporation emphasizing health care quality and outcomes studies. Inspired by the X-Prize Foundation, Dr. Merkin launched the Heritage Health Prize, a $3 million global incentivized competition seeking to achieve a fundamental breakthrough in our ability to predict future hospitalization. This led to additional incentivized competitions in cancer research, diabetes, open access health care apps for smartphones, etc., in conjunction with such organizations as Merck and the National Cancer Institute. For more information on the Merkin Brain and Health Policy Program, Please visit: Healthpolicy.usc.edu/Merkin_Fellowship.aspx