Wednesday, August 15, 2012
What if IVIG really worked for Alzheimer's?
ABC News and other media outlets are reporting the results of a small, but very important study regarding a new treatment for Alzheimer's Disease. Most Americans are familiar with Alzheimer's because it is so common (President Reagan had it), so devastating, and without a cure. This new study gives hope to people who have or are at risk for the disease.
This week at the Alzheimer's Association International Conference 2012 in Vancouver, researchers presented the positive results of a study using intravenous immunoglobulin, or IVIG, to successfully keep Alzheimer's disease at bay. Controversy exists because the study was very small (16 patients total), of which 11 patients took IVIG for three years and showed improvement thinking, memory, daily functions and mood.
Immunoglobulins are part of the human immune system. They are made naturally and help ward of a variety of infections and disease. IVIG has been used to treat a variety of auto-immune disease. Though no one is 100% sure how IVIG works, it is thought to have antibodies against amyloid. Amyloid is a protein which accumulates in the brains of patients who have Alzheimer's.
Though most experts caution current use in the general public and are clear that more research is needed, many believe this is a very good sign indeed.
However, let's assume that the research is proven correct, and that IVIG actually does work well for most patients to treat Alzheimer's disease. One of the problems is that IVIG is not cheap. Since it is a blood product, it is expensive. You need to get it from human donors, you need a nurse to administer it, and it must be given in a doctor's office or hospital. It is given once every two weeks, with an estimated to cost a patient $2,000 to $5,000.
According to data from Alzheimer's Association, there are 5.4 million Americans with Alzheimer's. If we take the low estimate of $2,000 every other week, it would cost $280 billion each year to treat patients with Alzheimer's.
In 2012, the direct costs of caring for those with Alzheimer's to American society will total an estimated $200 billion, including $140 billion in costs to Medicare and Medicaid. Essentially what this means is that it would cost nearly $100 billion dollars more each year to treat patients with IVIG and prevent Alzheimer's progression, than to simply treat this very expensive disease.
In some instances, like vaccines, an ounce of prevention is worth a pound of cure. However, in many examples, medical treatment is very expensive and keeping people alive and well cost more in the long run. It is our skyrocketing health care costs that plague our health care system and if we don't fix the problem soon, it could bankrupt our country.
Resources are not limitless. Since much of our health care is funded with taxpayer dollars, we as a society are going to have to make some very important decisions. If we decide that we think it is worth paying for everyone who has Alzheimer's to get IVIG for example, we are going to need to decide what we are not going to pay for to keep costs down. These are difficult decisions. The problem is that these types of conversations or not really happening today because the health care debate has become more about who will be the next President than actually solving our country's problems.
Matthew Mintz, MD, is a Fellow of the American College of Physicians. He is board certified in internal medicine and has been practicing for more than a decade. He is also an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients. This post originally appeared at Dr. Mintz' Blog. Conflict-of-interest disclosures are available here.
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