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. 2019 Oct;15(10):1309-1321.
doi: 10.1016/j.jalz.2019.05.004. Epub 2019 Aug 8.

Assessing cost-effectiveness of early intervention in Alzheimer's disease: An open-source modeling framework

Colin Green  1 , Ron Handels  2 , Anders Gustavsson  3 , Anders Wimo  4 , Bengt Winblad  5 , Anders Sköldunger  4 , Linus Jönsson  6
Affiliations

Assessing cost-effectiveness of early intervention in Alzheimer's disease: An open-source modeling framework

Colin Green et al. Alzheimers Dement. 2019 Oct.

Abstract

Introduction: We develop a framework to model disease progression across Alzheimer's disease (AD) and to assess the cost-effectiveness of future disease-modifying therapies (DMTs) for people with mild cognitive impairment (MCI) due to AD.

Methods: Using data from the US National Alzheimer's Coordinating Center, we apply survival analysis to estimate transition from predementia to AD dementia and ordered probit regression to estimate transitions across AD dementia stages. We investigate the cost-effectiveness of a hypothetical treatment scenario for people in MCI due to AD.

Results: We present an open-access model-based decision-analytic framework. Assuming a modest DMT treatment effect in MCI, we predict extended life expectancy and a reduction in time with AD dementia.

Discussion: Any future DMT for AD is expected to pose significant economic challenges across all health-care systems, and decision-analytic modeling will be required to assess costs and outcomes. Further developments are needed to inform these health policy considerations.

Keywords: Alzheimer's disease; Cost-effectiveness analysis; Decision-analytic modeling; Dementia; Health policy; Mild cognitive impairment; Prediction; Progression.

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Conflict of interest statement

B.W. acknowledges financial support from the Swedish Research Council, No 2018-02843 and from Margaretha af Ugglas’ Foundation. L.J. is an employee of H. Lundbeck, a pharmaceutical company that develops and markets therapies for Alzheimer’s disease. R.H. acknowledges financial support received from the Dutch Alzheimer’s Association, ‘Alzheimer Nederland’, against grant number WE.15-2016-09. A.G. is a partner of Quantify Research, providing consultancy services to pharmaceutical companies and other private and public organizations and institutions.

Figures

Fig. 1.
Fig. 1.
Schematic for AD model of disease progression. Abbreviations: MCI, mild cognitive impairment; AD, Alzheimer’s disease.
Fig. 2.
Fig. 2.
Profile across AD stages by group (predicted time/years in each stage). Abbreviations: CTRL, control/usual care; TREAT, treated with hypothetical DMT; MCI, mild cognitive impairment; AD, Alzheimer’s disease; DEM, dementia.
Fig. 3.
Fig. 3.
Cohort profile over time by disease severity/stage. Abbreviations: Tx, Treatment scenario; MCI, mild cognitive impairment (due to AD).
See this image and copyright information in PMC

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