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[P2–560]: CHALLENGES AND RECOMMENDATIONS FOR THE HEALTH‐ECONOMIC EVALUATION OF PRIMARY PREVENTION PROGRAMS FOR DEMENTIA
Author(s) -
Handels Ron,
Wimo Anders
Publication year - 2017
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.2017.06.1219
Subject(s) - dementia , reimbursement , medicine , psychological intervention , economic evaluation , intervention (counseling) , health care , cost–benefit analysis , gerontology , health economics , cost effectiveness , public health , nursing , risk analysis (engineering) , ecology , disease , pathology , economics , biology , economic growth
Background:A challenge in the treatment of patients with prodromal AD is the number of potential individuals for treatment. In order to manage the potential budget impact, strategies to identify individuals that will benefit most from treatment would be valuable. Methods:We simulated progression of 920 patients from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database with subjective memory concerns or mild cognitive impairment (mean ADAS-Cog 1⁄415.3). Patients were simulated over their remaining lifetimes using the AD Archimedes Condition-Event (ACE) simulator. The AD ACE incorporates a system of disease progression equations which predict temporal evolution using data from ADNI and literature. A hypothetical disease modifying treatment was constructed in the simulation which reduced the rate of cognitive decline by 20%. We evaluated the clinical benefit of treatment immediately versus receiving treatment after 1 year and versus no treatment. Where treatment was provided after 1 year, subpopulations were tested based on whether their ADAS-Cog had progressed by at least 1 point in year 1. Results: Immediate treatment was predicted to provide an additional 0.68 LY vs no treatment. This extended survival was accompanied by a 32% reduction in time spent in institutional care. Delaying treatment by one year reduced the survival benefit to 0.5 LY, but retained the benefit on institutional care, while reducing treatment duration by 11%. The majority of the benefit of treatment at 1 year was accrued by those patients with slower ADAS-Cog progression. Of the total 0.5 LYs gained with treatment starting at one year, only 0.09 LY was gained by patients whose ADAS-Cog increased by at least 1 point (49% of patients), while 0.41 LY was gained by those whose ADAS-Cog increased by less than 1 point (51% of patients). In contrast, the savings in institutional care was approximately equally split between the faster and slower progressing patients (52% and 48% of total time saved, respectively). The slower progressing patients received more treatment, representing 56% of the total treatment duration. Conclusions: Selectively treating patients based on observed rates of ADAS-Cog progression might have the potential to increase the survival benefit per treated patient, but had no impact on need for institutional care.