(110) Evaluating Lecanemab Eligibility for Patients in Skilled Nursing Facilities with Alzheimer's Disease or Mild Cognitive Impairment

Background: Nearly 4 million older adults receive care in U.S. nursing homes (NH) annually. Nearly half are diagnosed with Alzheimer’s disease (AD) or other dementias. NH patients with AD comprise a unique population of multimorbid adults for consideration of disease-modifying therapies (DMTs) such as lecanemab, however it is not yet known how many among this population may be eligible for such treatment.

Objectives: To apply lecanemab FDA product labeling criteria to a cohort of Medicare fee-for-service (FFS) beneficiaries with multiple chronic conditions and mild AD or mild cognitive impairment (MCI) receiving NH care in 2019.

Methods: We conducted a descriptive, cross-sectional study set in US NHs. The source population was all Medicare FFS beneficiaries who spent one or more days in a NH in 2019. Data sources included Medical Medicare Provider Analysis and Review, the Carrier File, Medicare Part D, the Chronic Conditions Warehouse, Minimum DataSet v.3.0, and the Medicare Beneficiary Summary File. Primary study inclusion criteria were met if NH patients had an AD or MCI diagnosis, were age 50 years or older, an intact or mild impairment, and were without contraindication to brain MRI.

Results: Among Medicare beneficiaries receiving NH care, 32,133 patients had an MCI or AD diagnosis. Of these, 11,284 were classified with mild cognitive impairment. After excluding 1,199 patients with typical contraindications to MRI, the final study population that met lecanemab product labeling criteria was composed of 10,085 (31.3%), including 7,038 patients with MCI and 2,599 with mild AD. Mean age was 80.3 years, most (65.8%) were female, 83.7% were White, 8.2% were Black, and 5.4% were Hispanic ethnicity (Figure 1). High rates of multiple chronic conditions, falls (53.9%), fracture (22.2%), and anticoagulation (22.2%) were observed.

Conclusions: As many as one-third of NH patients with MCI or AD are potential candidates for lecanemab treatment. Our findings provide a timely opportunity to highlight the need for additional research to 1) evaluate the safety and effectiveness of lecanemab therapy among NH patients with AD and multimorbidity, and 2) consider the implications of integrating substantial numbers of NH patients into the overburdened and fragmented care systems AD community-dwellers must navigate in order to be considered for lecanemab therapy.