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O2‐11‐04: Effect of Dementia Care Management on Healthcare Resource Utilization and Cost: One‐year follow‐Up Results of the Delphi Trial
Author(s) -
Michalowsky Bernhard,
Thyrian Jochen René,
Wucherer Diana,
Eichler Tilly,
Hertel Johannes,
Hoffmann Wolfgang
Publication year - 2016
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2016.06.457
Subject(s) - dementia , health care , randomized controlled trial , medicine , intervention (counseling) , delphi method , nursing , disease , statistics , surgery , mathematics , pathology , economics , economic growth
on several key biomarkers. Methods:We simulated the progression of patients with normal cognition (CN), mild cognitive impairment (MCI) and early AD over their remaining lifetimes using the AD Archimedes Condition-Event (ACE) simulator. AD ACE incorporates a system of disease progression equations which predict the temporal evolution of disease using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and the literature. A simulated hypothetical DMT directly reduced disease progression as indicated by cerebrospinal fluid (CSF) amyloid-beta, CSF t-tau, hippocampal MRI, and FDG-PET. No direct treatment effect was imposed on cognition, behavior, or function. Results:The hypothetical DMT provided 50% direct slowing on the rate of progression of amyloid-beta, t-tau, hippocampal MRI, and FDG-PET, which yielded a 15% slower rate of cognitive decline, as measured by MMSE. When simulated in patients with MCI, the DMT reduced the fraction of patients developing AD from 68% to 58%, despite a modest increase in survival (9 years with treatment vs. 8.5 years without). The treatment reduced the total cost of institutional care by 24%, driven approximately equally by fewer patients requiring institutional care and less time spent in institutional care for those that do require it. When treatment is provided to patients already diagnosed with early AD, the number of patients receiving treatment was reduced by 32% and the duration of treatment was reduced from 9 years to 3.8 years. However, the treatment benefit on total cost of institutional care was largely lost, with a reduction of 3%. Conclusions:A DMT could potentially reduce the amount of institutional care required in patients with MCI, but had a much smaller effect when provided only after patients develop AD.