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. 2022 Nov 15:11:38-46.
doi: 10.14283/jarlife.2022.7. eCollection 2022.

Modelling the Pan-European Economic Burden of Alzheimer's Disease

R Martins  1 , M Urbich  2 , K Brännvall  3 , M Gianinazzi  3 , J E Ching  4 , C P Khoury  4 , Y H El-Hayek  4
Affiliations

Modelling the Pan-European Economic Burden of Alzheimer's Disease

R Martins et al. JAR Life. .

Abstract

Background: Recent advances open the opportunity of altering the course of Alzheimer's disease (AD) through lifestyle-based modifications and novel therapies. Ensuring that society is investing limited budgets in the interventions that have the greatest potential to generate tangible impact will require tools to guide policymakers.

Objectives: To build on previous studies to develop an economic model that estimates the societal burden of AD and evaluates the potential impact of novel interventions in six large European countries.

Design: AD progression was modelled using a published Markov structure with a 40-year time horizon to estimate lifetime costs and life years in a cohort aged 65 years and above diagnosed with mild cognitive impairment due to AD (MCI-AD) in 2020. Demographic projections were utilized to estimate the prevalence of MCI-AD up to 2100, total corresponding costs and life years. The model allows a comparison of costs associated with the introduction of a hypothetical new disease-modifying therapy that slows disease progression between MCI-AD and all AD-Dementia stages as well as a 'delayed onset' scenario where disease progression is halted at the MCI-AD stage, potentially occurring, for example, through lifestyle-based modifications.

Results: The 2022 present value of total lifetime costs for this cohort moving through all disease stages is ~€1.2T. Approximately 80% of the present value of lifetime costs in our model are driven by informal care and non-medical direct costs. Our model suggests that a 25% and 50% reduction in disease progression compared to natural history could translate into a present value of cost savings of €33.7B and €72.7B. Halting MCI-AD progression for 3 years with no therapeutic effect thereafter resulted in a present value cost savings of €84.7B in savings.

Conclusions: Our data further suggest that early intervention via disease-modifying therapies or lifestyle-based modifications in AD could result in cost savings for society. Additionally, our findings reinforce the importance of accounting for the full value of innovative interventions, management and care paradigms, including their potential impact on direct, indirect and intangible costs impacting patients, their care partners and health and social care systems.

Keywords: Alzheimer’s disease; Europe; cost of illness; economic model.

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Conflict of interest statement

Rui Martins reports grants from Biogen International GmbH during the conduct of the study; and grants from Biogen International GmbH outside the submitted work. Michael Urbich is an employee of Biogen International GmbH. At the time of writing the manuscript, Karin Brännvall was an employee and stockholder of Biogen International GmbH. Mattia Gianinazzi is an employee and stockholder of Biogen International GmbH. Jamie Ching, Charles Khoury and Youssef El-Hayek report funding from Biogen International GmbH during the conduct of the study; other funding from Biogen International GmbH and from F. Hoffman-La Roche Ltd outside the submitted work; and are employees of Shift Health, providing consultancy services to organizations across the health and life sciences sector. All authors contributed to the design of this study, the collection, analysis, and interpretation of data, and the preparation and review of the manuscript.

Figures

Figure 1
Figure 1
Forecasted pan-European prevalence of MCI-AD from 2022 to 2100
Figure 2
Figure 2
Present value of the lifetime AD-related costs by cost type for a cohort of patients aged 65 and over with prevalent
Figure 3
Figure 3
Present value of the lifetime AD-related costs and life years for a cohort of patients aged 65 years and over with prevalent MCI-AD up to 2100
Figure 4
Figure 4
Three scenarios reducing disease progression and delaying disease onset on the present value of the lifetime
Figure 1:
Figure 1:
Three scenarios assessing the impact of Hypothetical DMT on the present value of the lifetime AD-related costs for a cohort aged 65 and over with prevalent MCI-AD in 2022 for France (A), Germany (B), Italy (C), Spain (D), Sweden (E), and the UK (F).
Figure 1:
Figure 1:
Three scenarios assessing the impact of Hypothetical DMT on the present value of the lifetime AD-related costs for a cohort aged 65 and over with prevalent MCI-AD in 2022 for France (A), Germany (B), Italy (C), Spain (D), Sweden (E), and the UK (F).
Figure 1:
Figure 1:
Three scenarios assessing the impact of Hypothetical DMT on the present value of the lifetime AD-related costs for a cohort aged 65 and over with prevalent MCI-AD in 2022 for France (A), Germany (B), Italy (C), Spain (D), Sweden (E), and the UK (F).
Figure 1:
Figure 1:
Three scenarios assessing the impact of Hypothetical DMT on the present value of the lifetime AD-related costs for a cohort aged 65 and over with prevalent MCI-AD in 2022 for France (A), Germany (B), Italy (C), Spain (D), Sweden (E), and the UK (F).
Figure 1:
Figure 1:
Three scenarios assessing the impact of Hypothetical DMT on the present value of the lifetime AD-related costs for a cohort aged 65 and over with prevalent MCI-AD in 2022 for France (A), Germany (B), Italy (C), Spain (D), Sweden (E), and the UK (F).
Figure 1:
Figure 1:
Three scenarios assessing the impact of Hypothetical DMT on the present value of the lifetime AD-related costs for a cohort aged 65 and over with prevalent MCI-AD in 2022 for France (A), Germany (B), Italy (C), Spain (D), Sweden (E), and the UK (F).
Figure 2:
Figure 2:
Three scenarios assessing the impact of a Hypothetical DMT (25% and 50% reduction in progression) and potential lifestyle-based interventions (3 year delay in progression) on the present value of the lifetime AD-related costs for a cohort aged 65 and over with prevalent MCI-AD in 2022 for Canada (A) and the USA (B).
Figure 2:
Figure 2:
Three scenarios assessing the impact of a Hypothetical DMT (25% and 50% reduction in progression) and potential lifestyle-based interventions (3 year delay in progression) on the present value of the lifetime AD-related costs for a cohort aged 65 and over with prevalent MCI-AD in 2022 for Canada (A) and the USA (B).
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