Article

An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom.

United BioSource Corporation, Lexington, MA, USA.
Alzheimer's & dementia: the journal of the Alzheimer's Association (Impact Factor: 14.48). 03/2011; 8(1):22-30. DOI:10.1016/j.jalz.2010.07.001
Source: PubMed

ABSTRACT Diagnosing and treating patients with Alzheimer's disease (AD) at an early stage should improve the quality of life of the patient and caregiver. In the United Kingdom, cost-effectiveness of early assessment of individuals presenting with subjective memory complaints and treating those with AD with donepezil was evaluated.
A discrete event simulation of AD progression and the effect of treatment interventions was developed. Patient-level data from donepezil trials and a 7-year follow-up registry were used to model correlated longitudinal rates of change in cognition, behavior, and function. Other epidemiological and health services data, including estimates of undiagnosed dementia and delays in diagnosis, were based on published sources. Simulated individuals were followed up for 10 years.
In the base-case estimates, 17 patients need to be assessed to diagnose one patient with AD, resulting in an average assessment cost of £4100 ($6000; $1 US = £0.68 UK) per patient diagnosed (2007 cost year). In comparison with a scenario without early assessment or pharmacologic treatment, early assessment reduces health care costs by £3600 ($5300) per patient and societal costs by £7750 ($11,400). Savings are also substantial compared with treatment without early assessment, averaging £2100 ($3100) in health care costs, and £5700 ($8400) in societal costs. Results are most sensitive to estimates of patient care costs and the probability of patients reporting subjective memory complaints. In probabilistic sensitivity analysis, early assessment leads to savings or is highly cost-effective in the majority of cases.
Although early assessment has significant up-front costs, identifying AD patients at an early stage results in cost savings and health benefits compared with no treatment or treatment in the absence of early assessment.

0 0
 · 
0 Bookmarks
 · 
36 Views
  • [show abstract] [hide abstract]
    ABSTRACT: To systematically review approaches and instruments used to derive utility weights in cost-utility analyses (CUAs) within the field of mental disorders and to identify factors that may have influenced the choice of the approach. We searched the databases DARE (Database of Abstracts of Reviews of Effects), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment), and PubMed for CUAs. Studies were included if they were full economic evaluations and reported quality-adjusted life-years as the health outcome. Study characteristics and instruments used to estimate utility weights were described and a logistic regression analysis was conducted to identify factors associated with the choice of either the direct (e.g. standard gamble) or the preference-based measure (PBM) approach (e.g. EQ-5D). We identified 227 CUAs with a maximum in 2009, 2010, and 2012. Most CUAs were conducted in depression, dementia, or psychosis, and came from the US or the UK, with the EQ-5D being the most frequently used instrument. The application of the direct approach was significantly associated with depression, psychosis, and model-based studies. The PBM approach was more likely to be used in recent studies, dementia, Europe, and empirical studies. Utility weights used in model-based studies were derived from only a small number of studies. We only searched four databases and did not evaluate the quality of the included studies. Direct instruments and PBMs are used to elicit utility weights in CUAs with different frequencies regarding study type, mental disorder, and country.
    PharmacoEconomics 11/2013; · 2.86 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Alzheimer's disease (AD) is a chronic neurodegenerative disease leading to cognitive decline, dementia, and ultimately death. Despite extensive R&D efforts, there are no diseases modifying treatments for AD available. The stage in which patients receive a clinical diagnosis of probable AD may be too late for disease modifying pharmacotherapy. Prevention strategies may be required to successfully tackle AD. Preclinical AD applies to over half of all healthy elderly subjects and manifests by signs of amyloid deposition and/or neuronal injury in the brain, preceding the stage in which symptoms of dementia, cognitive and functional impairment become observable. Prevention trials in preclinical AD require longer and larger clinical trials using biomarkers and cognitive endpoints, which requires collaboration across academia, government and industry.
    Current Opinion in Pharmacology 02/2014; 14(1):18–22. · 5.44 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: ALzheimer's COoperative Valuation in Europe (ALCOVE) was a Joint Action co-financed by the European Commission to produce a set of evidence-based recommendations for policymakers on dementia. This paper reports on timely diagnosis. Evidence was reviewed from scientific, policy and qualitative research. An online questionnaire was completed by experts from 24 European Union countries detailing current practice. An iterative process with people with dementia, family carers and professionals was utilised to develop recommendations. Advances in the technical aspects of diagnosis have changed what is understood by early diagnosis. Although research into preclinical stages is crucial, diagnosing at these very earliest stages is not recommended as regular practice. On balance, it is suggested that citizens should have access to accurate diagnosis at a time in the disease process when it can be of most benefit to them. The term timely diagnosis is used to reflect this. The diagnosis can help citizens and their families make sense of what is happening and make lifestyle changes and plans for the future. The central principles identified to maximise benefit and to reduce harm associated with diagnosis at an earlier stage included reducing stigma about dementia; respecting the rights of the individual; recognising that how the diagnosis is given will impact on subsequent adjustment and that post diagnostic support are required for the person and their family. Detailed recommendations are provided for timely detection, the diagnostic process, complex diagnoses, response to early cognitive changes and workforce. The recommendations can be utilised at a local, national and European level to benchmark progress. Copyright © 2014 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 01/2014; · 2.98 Impact Factor

Full-text

View
0 Downloads

Dennis Getsios