: Alzheimer's disease (AD) affects over 4 million Americans, an estimate that is projected to increase to 14 million by 2050. Technological advances have led to the approval of 5 drugs to treat AD. While the demand for these drugs has been rising rapidly since their introduction, there is little nationally representative research available on individuals who use them. The proposed research has 3 main objectives. First, it will examine the trends in diffusion of AD drugs among community residing Medicare beneficiaries from 1996 to 2002. Second, the study will determine if disparities exist in the adoption and use of drugs for AD. Finally, it would identify the determinants of current and future health care costs associated with the adoption and use of these drugs. All the 3 objectives directly relate to the mission of the agency with reference to health and health care of the elderly and minority populations. The Anderson's behavioral model of health services utilization and the Roger's diffusion of innovations model provide the conceptual framework for the study. Data on community dwelling beneficiaries from the Medicare Current Beneficiary Survey, years 1996 to 2002, and data on health care systems from the Area Resource File will be used. Analysis procedures would be conducted on 3 samples: beneficiaries with only a claims diagnosis of AD, beneficiaries with a claims diagnosis or a survey report of AD, and beneficiaries with a claims diagnosis, or survey report of AD or those using any AD drug. This categorization would help in determining how the results would change based on varying sample definitions. Analyses procedures will include conducting basic descriptive analysis on the numbers and types of drugs that are used by elderly with AD. Chi-squares would be used to test for absolute differences in the utilization of AD drugs by beneficiaries with AD. The trends in diffusion would be captured by estimating hazard models on adoption of AD drug by beneficiaries from 1996 to 2001. Disparities would be identified in 2 ways. First by estimating logit models for each year of available data and second by pooling the data and estimating a multilevel model where persons nested within a given year. In addition, racial difference would be calculated using Oaxaca decomposition techniques. Finally, the Generalized Linear Model using gamma regression functions would be employed to analyze current and projected costs. Findings from this study would help in integrating aspects of access, quality and costs of health care services such as prescription drugs for elderly with Alzheimer's disease. ? ? ? ?
