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. 2020;75(3):891-902.
doi: 10.3233/JAD-191055.

Quantifying and Describing the Natural History and Costs of Alzheimer's Disease and Effects of Hypothetical Interventions

Anders Wimo  1   2 , Ron Handels  1   3 , Bengt Winblad  1 , Christopher M Black  4 , Gunilla Johansson  1 , Stina Salomonsson  5 , Maria Eriksdotter  6   7 , Rezaul K Khandker  4
Affiliations

Quantifying and Describing the Natural History and Costs of Alzheimer's Disease and Effects of Hypothetical Interventions

Anders Wimo et al. J Alzheimers Dis. 2020.

Erratum in

Abstract

Background: A long-term horizon is necessary when the socioeconomic consequences and the potential effects of interventions in Alzheimer's disease (AD) are estimated.

Objectives: To illustrate the potential societal costs of AD across the disease continuum and to illustrate the potential cost-effectiveness of a hypothetical intervention with disease modifying treatment (DMT).

Methods: Based on the Swedish dementia registry, a Markov model was used to simulate a virtual cohort of 100,000 people with mild cognitive impairment (MCI) due to AD (AD-MCI) in Sweden for 40 years starting at the age of 60. A simulated hypothetical intervention assumed a 25% reduction in progression rate during AD-MCI and mild AD-dementia. A comprehensive set of sensitivity analyses was included.

Results: The cumulative risk to develop dementia was 96%. The mean simulated survival was 19.0 years. The net present value for a person year with dementia was 252,843 SEK (about 29,500 US$). The cost effectiveness model illustrated how the hypothetical scenario of a 25% reduction in progression to AD-dementia would require 41 AD-MCI patients to be treated to prevent one case of AD-dementia (2,447 avoided AD-dementia cases of 100,000 with AD-MCI). Most scenarios illustrated hypothetical cost effectiveness (based on a willingness to pay level of 600,000 SEK (70,000 US$) per gained QALY), but not cost savings.

Discussion: Lifetime societal costs of AD are substantial. A future DMT may be potentially cost-effective given assumed treatment effects and costs, but cost savings are unlikely.

Keywords: Alzheimer’s disease; cost analysis; cost effectiveness; costs; dementia; disease-modifying treatment; economics.

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Conflict of interest statement

Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/19-1055r2).

Figures

Fig. 1
Fig. 1
The basic structure of the dementia progression model.
Fig. 2
Fig. 2
The course of the simulated cohort during the simulated period of 40 years. Year 0 = start age 60.
See this image and copyright information in PMC

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