Early intervention in Alzheimer's disease: a health economic study of the effects of diagnostic timing.
Early intervention in Alzheimer's disease: a health economic study of the effects of diagnostic timing.
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DOI：
10.1186/1471-2377-14-101
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发表时间：
2014-05-07
期刊：
影响因子：
2.6
通讯作者：
Taylor M
中科院分区：
文献类型：
--
作者：
Barnett JH;Lewis L;Blackwell AD;Taylor M
阿尔茨海默病痴呆症（AD-痴呆症）的干预和治疗可能具有成本效益，但大多数患者没有及时诊断。现在有技术可以早期检测与早期痴呆症相关的认知丧失，为英国医疗保健系统的早期干预提供了可能。本研究旨在确定干预措施的时机在多大程度上影响其成本效益。使用已发表的描述AD诊断前几年认知功能下降的数据，我们模拟了假设的症状和疾病改善干预措施对医疗保健成本和质量调整生命年的影响。早期干预和标准干预被认为具有相同的临床效果，但早期干预可以在标准诊断前8年应用。在考虑的最早时间点（即标准诊断前8年）应用时，立即将认知改善1个MMSE点并在3年内降低疗效的对症治疗将产生最大净获益。在这种情况下，干预措施每延迟一年，净效益就会减少约17%。相比之下，对于阻止认知下降一年的疾病改善干预措施，当在标准诊断前两年应用治疗效果时，经济效益将达到峰值。在这些模型中，疾病改善干预的最大净效益是对症治疗的15倍。干预的时机可能对当前和未来治疗的成本效益产生重要影响。医疗保健政策应旨在优化AD痴呆诊断的时机，这可能需要在当前临床实践之前几年检测和治疗患者。
Intervention and treatment in Alzheimer’s disease dementia (AD-dementia) can be cost effective but the majority of patients are not diagnosed in a timely manner. Technology is now available that can enable the earlier detection of cognitive loss associated with incipient dementia, offering the potential for earlier intervention in the UK health care system. This study aimed to determine to what extent the timing of an intervention affects its cost-effectiveness. Using published data describing cognitive decline in the years prior to an AD diagnosis, we modelled the effects on healthcare costs and quality-adjusted life years of hypothetical symptomatic and disease-modifying interventions. Early and standard interventions were assumed to have equal clinical effects, but the early intervention could be applied up to eight years prior to standard diagnosis. A symptomatic treatment which immediately improved cognition by one MMSE point and reduced in efficacy over three years, would produce a maximum net benefit when applied at the earliest timepoint considered, i.e. eight years prior to standard diagnosis. In this scenario, the net benefit was reduced by around 17% for every year that intervention was delayed. In contrast, for a disease-modifying intervention which halted cognitive decline for one year, economic benefits would peak when treatment effects were applied two years prior to standard diagnosis. In these models, the maximum net benefit of the disease modifying intervention was fifteen times larger than that of the symptomatic treatment. Timeliness of intervention is likely to have an important impact on the cost-effectiveness of both current and future treatments. Healthcare policy should aim to optimise the timing of AD-dementia diagnosis, which is likely to necessitate detecting and treating patients several years prior to current clinical practice.
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DOI：
10.1016/j.jalz.2011.03.005
发表时间：
2011-05
期刊：
Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子：
--
作者：
McKhann GM;Knopman DS;Chertkow H;Hyman BT;Jack CR Jr;Kawas CH;Klunk WE;Koroshetz WJ;Manly JJ;Mayeux R;Mohs RC;Morris JC;Rossor MN;Scheltens P;Carrillo MC;Thies B;Weintraub S;Phelps CH
通讯作者：
Phelps CH
影响因子：
2.1
作者：
Bradford A;Kunik ME;Schulz P;Williams SP;Singh H
通讯作者：
Singh H
影响因子：
14
作者：
Gustavsson, Anders;Brinck, Per;Jonsson, Linus
通讯作者：
Jonsson, Linus
影响因子：
14
作者：
Lin, Pei-Jung;Neumann, Peter J.
通讯作者：
Neumann, Peter J.
影响因子：
3.3
作者：
Gerves, Chloe;Chauvin, Pauline;Bellanger, Martine Marie
通讯作者：
Bellanger, Martine Marie