Microsimulation Modeling to Compare the Effectiveness and Cost-Effectiveness of Nondrug Interventions to Manage Clinical Symptoms in Racially/Ethnically Diverse Persons with Dementia

项目摘要 阿尔茨海默病和相关疾病(ADRD)影响着500万美国人，影响不成比例 这对少数族裔人口造成了巨大的经济影响。特别是两个临床特征：功能性 衰弱和行为症状，与更多的照顾和医疗保险/医疗补助/家庭相关 仅与认知能力下降相比，支出就会减少。帮助患有ADRD的患者留在家中 为了提高生活质量，至关重要的是向家庭照料者--最大的ADRD护理提供者--提供有效的支持。 与药物(如抗精神病药物)不同，非药物ADRD干预与不良事件和 被推荐作为一线治疗。系统评价得出的结论是，非药物二元干预 让ADRD患者参与进来，并为照顾者提供有效维持或减缓功能衰退的技能 和/或减少ADRD相关行为。目前尚不清楚这些经过验证的计划对以下结果的影响 在整个疾病轨迹中与家庭和政策制定者的相关性(例如，照顾所花费的时间)以及 影响是否因种族/民族而异。在使用养老院方面的种族/民族差异，支付能力 卫生保健和家庭结构可能会影响干预措施的人口有效性。为了回应PAR- 18-331，我们建议在仿真建模中使用创新的方法来扩展已完成的发现 选择二元干预措施的随机对照试验(RCT)。具体来说，我们将使用我们发布的 ADRD微模拟模型(ADRD-MM)用于推断已证实的二元干预措施对预后的影响 护理时间，疗养院的天数，费用，以及患有ADRD的人和他们的照顾者的质量- 调整后的寿命年数。我们还将根据种族/民族评估结果。我们的模拟模型使用了来自 国家阿尔茨海默氏症协调中心，健康和退休研究，以及医疗保险，以模拟 ADRD事件患者的功能、行为和认知能力下降，以及相关的家庭和政策后果。 在我们提议的研究中，我们确定了八种已证实的二元干预措施，它们符合我们的纳入标准 1)在患有ADRD的美国社区居民和/或他们的照顾者中进行RCT测试，以及2) 提供效果大小和足够数据以估算执行成本的成果出版物。使用 ADRD-MM，我们的具体目标是：1)确定种族(非裔美国人、亚洲人和白人)的影响 和种族(西班牙裔)已确定的非药物ADRD二元干预家庭小时照看，天数 养老院，家庭费用/医疗补助/医疗保险，以及ADRD患者的质量调整寿命年 和他们的照顾者；2)按种族比较有效性、成本效益和可负担性(非裔美国人， 已确定的ADRD干预措施的种族(亚裔和白人)和种族(西班牙裔)；以及3)确定 确定的ADRD干预措施应按种族(非裔美国人、亚洲人和白人)进行额外试验测试 和种族(西班牙裔)，以告知非药物ADRD研究的优先顺序。我们的研究将提供有关 非药物ADRD干预对社会结局的影响和扩大随机对照试验的证据基础。

Project Summary Alzheimer’s Disease and Related Disorders (ADRD) affects >5 million Americans, disproportionately impacts minority populations, and has significant economic consequences. Two clinical features in particular: functional decline and behavioral symptoms, are associated with more caregiving and Medicare/Medicaid/family expenditures when compared to cognitive decline alone. To help individuals with ADRD remain at home with quality of life, it is vital to provide family caregivers, the largest providers of ADRD care, with effective support. Unlike drugs (e.g., antipsychotics), nondrug ADRD interventions are not associated with adverse events and are recommended as first-line treatments. Systematic reviews conclude that nondrug dyadic interventions that engage the person with ADRD and provide caregivers skills effectively maintain or slow functional decline and/or reduce ADRD-related behaviors. It is unclear as to the effects of these proven programs on outcomes of relevance to families and policymakers (e.g., time spent caregiving) throughout the disease trajectory and whether effects differ by race/ethnicity. Racial/ethnic differences in the use of nursing homes, ability to pay for health care, and family structures may impact population effectiveness of interventions. In response to PAR- 18-331, we propose to use innovative methods in simulation modeling to extend findings from completed randomized controlled trials (RCTs) on select dyadic interventions. Specifically, we will use our published ADRD microsimulation model (ADRD-MM) to infer the effect of proven dyadic interventions on outcomes of hours caregiving, days in a nursing home, costs, and the person with ADRD’s and their caregiver’s quality- adjusted life-years. We will also evaluate outcomes by race/ethnicity. Our simulation model used data from the National Alzheimer’s Coordinating Center, the Health and Retirement Study, and Medicare to simulate an incident ADRD case’s decline in function, behavior, and cognition and associated family and policy outcomes. For our proposed study, we have identified eight proven dyadic interventions that meet our inclusion criteria of 1) being tested in RCTs in US community-dwelling persons with ADRD and/or their caregivers and 2) having outcome publications that provided effect sizes and sufficient data to estimate implementation cost. Using the ADRD-MM, our specific aims are to: 1) Determine the effects by race (African American, Asian, and White) and ethnicity (Hispanic) of identified nondrug ADRD dyadic interventions on family hours caregiving, days in a nursing home, costs to families/Medicaid/Medicare, and quality-adjusted life-years of the person with ADRD and their caregivers; 2) compare effectiveness, cost-effectiveness, and affordability by race (African American, Asian, and White) and ethnicity (Hispanic) of the identified ADRD interventions; and 3) determine which of the identified ADRD interventions should be tested in additional trials by race (African American, Asian, and White) and ethnicity (Hispanic) to inform nondrug ADRD research prioritization. Our study will yield new data on the impact of nondrug ADRD interventions on societal outcomes and extend the evidence-base of RCTs.