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）影响超过500万美国人，不成比例地影响 少数族裔人口，并产生重大的经济后果。特别是两个临床特征：功能 下降和行为症状，与更多的生育和医疗保险/医疗补助/家庭 与认知能力下降相比。为了帮助ADRD患者留在家中， 为了提高生活质量，至关重要的是为家庭照顾者提供有效的支持，家庭照顾者是ADRD护理的最大提供者。 与药物不同（例如，抗精神病药物），非药物ADRD干预与不良事件无关， 被推荐为一线治疗。系统性综述的结论是， 使ADRD患者参与并提供护理人员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方案对治疗结果的影响。 与家庭和决策者的相关性（例如，在整个疾病轨迹中花费的时间）， 影响是否因种族/民族而异。使用养老院的种族/民族差异，支付能力 保健和家庭结构可能影响干预措施的人口效力。为了响应PAR- 18-331，我们建议在模拟建模中使用创新方法， 随机对照试验（RCT）选择二元干预。具体而言，我们将使用我们发布的 ADRD微观模拟模型（ADRD-MM），用于推断已证实的二元干预措施对 时间，在疗养院的天数，费用，以及ADRD患者及其护理人员的质量- 调整生命年我们还将按人种/种族评价结局。我们的模拟模型使用的数据来自 国家阿尔茨海默氏症协调中心，健康和退休研究，和医疗保险，以模拟一个 事件ADRD病例的功能、行为和认知下降以及相关的家庭和政策结果。 对于我们提出的研究，我们已经确定了八种经过验证的二元干预措施，符合我们的纳入标准， 1)在美国社区ADRD患者和/或其护理人员的RCT中进行测试，2） 结果出版物提供了效应量和足够的数据来估计实施成本。使用 ADRD-MM，我们的具体目标是：1）确定人种（非裔美国人、亚洲人和白色人）的影响 和种族（西班牙裔）确定的非药物ADRD二元干预对家庭小时数，天数， 疗养院、家庭/医疗补助/医疗保险费用以及ADRD患者的质量调整生命年 和他们的照顾者; 2）比较有效性，成本效益，和负担能力的种族（非洲裔美国人， 亚洲和白色）和种族（西班牙裔）;以及3）确定 已确定的ADRD干预措施应按人种（非裔美国人、亚洲人和白色人）在其他试验中进行测试 和种族（西班牙裔），以告知非药物ADRD研究的优先顺序。我们的研究将产生新的数据 非药物ADRD干预对社会结局的影响，并扩展RCT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.