Current issues and future research priorities for health economic modelling across the full continuum of Alzheimer's disease

Abstract

Available data and models for the health-economic evaluation of treatment in Alzheimer's disease (AD) have limitations causing uncertainty to decision makers. Forthcoming treatment strategies in preclinical or early AD warrant an update on the challenges associated with their economic evaluation. The perspectives of the co-authors were complemented with a targeted review of literature discussing methodological issues and data gaps in AD health-economic modelling. The methods and data available to translate treatment efficacy in early disease into long-term outcomes of relevance to policy makers and payers are limited. Current long-term large-scale data accurately representing the continuous, multifaceted, and heterogeneous disease process are missing. The potential effect of disease-modifying treatment on key long-term outcomes such as institutionalization and death is uncertain but may have great effect on cost-effectiveness. Future research should give priority to collaborative efforts to access better data on the natural progression of AD and its association with key long-term outcomes.

Challenges and recommendations for the health-economic evaluation of primary prevention programmes for dementia

“…Since mortality rates increase with age, the time spent in these care-intensive stages will then be shorter. Various theoretical scenarios for the balance between costs and savings in relation to a reduced rate of disease progression and mortality have been discussed (Gustavsson et al, 2017).…”

“…Health-economic evidence could also be used to identify which parts of evidence cause decision uncertainty (e.g. the impact of dementia-related mortality has been identified as a likely factor causing decision uncertainty (Gustavsson et al, 2017)). Health-economic evidence reflecting on the potential of an intervention under development can be used to anticipate further development or support governments in making decisions regarding potentially new medical interventions.…”

Nursing Home Use Across The Spectrum of Cognitive Decline: Merging Mayo Clinic Study of Aging With CMS MDS Assessments

“…While awaiting clinical‐trial confirmation, disease‐modifying effects at earlier disease stages have been reported in observational studies of exercise, social engagement, and diet . However, as noted by Gustavsson et al, if any treatments are confirmed as having a positive effect on underlying pathology, such effects must also be translatable as having real life relevance for patients, care providers, and society at large (e.g., improved quality of life, greater independence, reduced care needs, and lower costs).…”

“…There is little evidence that underlying pathology is modified by existing pharmaceuticals designed to treat dementia . Thus, research is expanding beyond pharmacological treatment after symptoms become apparent to: (1) enhancing quality of life, improving care, and reducing care needs for persons living with dementia, and (2) preventing/postponing disease progression by detecting and treating disease at earlier stages . While awaiting clinical‐trial confirmation, disease‐modifying effects at earlier disease stages have been reported in observational studies of exercise, social engagement, and diet .…”

“…The serious limitations of these approaches for estimating associations between healthcare utilization and cognitive impairment are demonstrated . The need for objective, complete measures of utilization by persons carefully characterized for cognition across the spectrum of cognitive decline is increasingly recognized …”