Skip to main content
Erschienen in: The European Journal of Health Economics 2/2004

01.05.2004 | Original Papers

Potential cost-effectiveness of a family-based program in mild Alzheimer’s disease patients

verfasst von: Janne Martikainen, Hannu Valtonen, Tuula Pirttilä

Erschienen in: The European Journal of Health Economics | Ausgabe 2/2004

Einloggen, um Zugang zu erhalten

Abstract

Alzheimer’s disease (AD) is a chronic and progressive neurodegenerative disease characterized by a progressive deterioration in cognitive functions. AD will have a major impact on public health in the coming decades. The objective of this study was to evaluate the potential cost-effectiveness of a cognitive-behavioral family intervention (CBFI) program in patients with mild Alzheimer’s disease in Finland. A second-order Monte Carlo technique was used to simulate the effectiveness of the intervention in AD patients and their informal caregivers over the course of 5 years. A Bayesian approach was applied to answer the question: how likely is it that the CBFI program is cost-effective? Based on existing information, the incremental net health benefit of the CBFI program is positive with over 0.9 probability, which indicates that the CBFI program has the highest probability of being optimal by providing greater net benefits than current practice. Furthermore, changes in the health-related quality of life of the caregivers were insensitive to AD patients’ disease stage and settings of care. From the methodological point of view, the acceptability curve with a Bayesian approach provides a flexible way to characterize uncertainty surrounding cost-effectiveness parameters.
Literatur
1.
Zurück zum Zitat Sulkava R, Wikström J, Aromaa A, Raitasalo R, Lehtinen V, Lahtela K, Palo J (1985) Prevalence of severe dementia in Finland. Neurology 35:1025–1029PubMed Sulkava R, Wikström J, Aromaa A, Raitasalo R, Lehtinen V, Lahtela K, Palo J (1985) Prevalence of severe dementia in Finland. Neurology 35:1025–1029PubMed
2.
Zurück zum Zitat Evans DA, Funkenstein HH, Albert MS, Scherr PA, Cook NR, Chown MJ, Hebert LE, Hennekens CH, Taylor JO (1989) Prevalence of Alzheimer’s disease in a community population of older persons. JAMA 262:2551–2556PubMed Evans DA, Funkenstein HH, Albert MS, Scherr PA, Cook NR, Chown MJ, Hebert LE, Hennekens CH, Taylor JO (1989) Prevalence of Alzheimer’s disease in a community population of older persons. JAMA 262:2551–2556PubMed
3.
Zurück zum Zitat Bachman DL, Wolf PA, Linn R, Knoefel JE, Cobb J, Belanger A, D’Agostino RB, White LR (1992) Prevalence of dementia and probable senile dementia of the Alzheimer type in the Framingham study. Neurology 42:115–119PubMed Bachman DL, Wolf PA, Linn R, Knoefel JE, Cobb J, Belanger A, D’Agostino RB, White LR (1992) Prevalence of dementia and probable senile dementia of the Alzheimer type in the Framingham study. Neurology 42:115–119PubMed
4.
Zurück zum Zitat Skoog I, Nilsson L, Palmertz B, Andreasson L-A, Svanborg A (1993) A population-based study of dementia in 85-year-olds. N Engl J Med 328:153–158CrossRefPubMed Skoog I, Nilsson L, Palmertz B, Andreasson L-A, Svanborg A (1993) A population-based study of dementia in 85-year-olds. N Engl J Med 328:153–158CrossRefPubMed
5.
Zurück zum Zitat Ott A, Breteler MMB, Harskamp van F, Claus JJ, Cammen van der TJM, Grobbee DE, Hofman A (1995) Prevalence of Alzheimer’s disease and vascular dementia: association with education. The Rotterdam study. BMJ 310:970–973PubMed Ott A, Breteler MMB, Harskamp van F, Claus JJ, Cammen van der TJM, Grobbee DE, Hofman A (1995) Prevalence of Alzheimer’s disease and vascular dementia: association with education. The Rotterdam study. BMJ 310:970–973PubMed
6.
Zurück zum Zitat Polvikoski T, Sulkava R, Myllykangas L, Notkola I-L, Niinistö L, Verkkoniemi A, Kainulainen K, Kontula K, Perez-Tur J, Hardy J, Haltia M (2001) Prevalence of Alzheimer’s disease in very elderly people. A prospective neuropathological study. Neurology 56:1690–1696PubMed Polvikoski T, Sulkava R, Myllykangas L, Notkola I-L, Niinistö L, Verkkoniemi A, Kainulainen K, Kontula K, Perez-Tur J, Hardy J, Haltia M (2001) Prevalence of Alzheimer’s disease in very elderly people. A prospective neuropathological study. Neurology 56:1690–1696PubMed
7.
Zurück zum Zitat Wimo A, Ljunggren G, Winblad B (1997) Costs of dementia and dementia care–a review. Int J Geriatr Psychiatry 12:841–856CrossRefPubMed Wimo A, Ljunggren G, Winblad B (1997) Costs of dementia and dementia care–a review. Int J Geriatr Psychiatry 12:841–856CrossRefPubMed
8.
Zurück zum Zitat Hu T, Huang L, Cartwright WS (1986) Evaluation of the costs of caring for the senile demented elderly: a pilot study. Gerontologist 26:158–163PubMed Hu T, Huang L, Cartwright WS (1986) Evaluation of the costs of caring for the senile demented elderly: a pilot study. Gerontologist 26:158–163PubMed
9.
Zurück zum Zitat Braak H, Braak E (1991) Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol (Berl) 82:239–259 Braak H, Braak E (1991) Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol (Berl) 82:239–259
10.
Zurück zum Zitat Jost BC, Grossberg GT (1995) The natural history of Alzheimer’s disease: a brain bank study. J Am Geriatr Soc 43:1248–1255 Jost BC, Grossberg GT (1995) The natural history of Alzheimer’s disease: a brain bank study. J Am Geriatr Soc 43:1248–1255
11.
Zurück zum Zitat Knopman D, Schneider L, Davis K, Talwalker S, Smith F, Hoover T, Gracon S (1996) Long-term tacrine treatment: effects on nursing home placement and mortality. Neurology 47:166–177PubMed Knopman D, Schneider L, Davis K, Talwalker S, Smith F, Hoover T, Gracon S (1996) Long-term tacrine treatment: effects on nursing home placement and mortality. Neurology 47:166–177PubMed
12.
Zurück zum Zitat Brodaty H, Gresham M, Luscombe G (1997) The Prince Henry Hospital dementia caregiver training program. Int J Geriatr Psychiatry 12:183–192CrossRefPubMed Brodaty H, Gresham M, Luscombe G (1997) The Prince Henry Hospital dementia caregiver training program. Int J Geriatr Psychiatry 12:183–192CrossRefPubMed
13.
Zurück zum Zitat Eloniemi-Sulkava U, Notkola I-L, Hentinen M, Kivelä S-L, Sivenius J, Sulkava R (2001) Effects of supporting community-living demented patients and their caregivers: a randomized trial. J Am Geriatr Soc 49:1282–1287 Eloniemi-Sulkava U, Notkola I-L, Hentinen M, Kivelä S-L, Sivenius J, Sulkava R (2001) Effects of supporting community-living demented patients and their caregivers: a randomized trial. J Am Geriatr Soc 49:1282–1287
14.
Zurück zum Zitat Mittelman MS, Ferris SH, Shulman E, Steinberg G, Levin B (1996) A family intervention to delay nursing home placement of patients with Alzheimer’s disease. JAMA 276:1725–1731CrossRefPubMed Mittelman MS, Ferris SH, Shulman E, Steinberg G, Levin B (1996) A family intervention to delay nursing home placement of patients with Alzheimer’s disease. JAMA 276:1725–1731CrossRefPubMed
15.
Zurück zum Zitat Stinnett AA, Paltiel AD (1997) Estimating CE ratios under second-order uncertainty: the mean ratio versus the ratio of means. Med Decis Making 17:483–489PubMed Stinnett AA, Paltiel AD (1997) Estimating CE ratios under second-order uncertainty: the mean ratio versus the ratio of means. Med Decis Making 17:483–489PubMed
16.
Zurück zum Zitat Neumann PJ, Hermann RC, Kuntz KM, Araki SS, Duff SB, Leon J, PA Berenbaum PA, Goldman PA, Williams LW, Weinstein MC (1999) Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease. Neurology 52:1138–1145PubMed Neumann PJ, Hermann RC, Kuntz KM, Araki SS, Duff SB, Leon J, PA Berenbaum PA, Goldman PA, Williams LW, Weinstein MC (1999) Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease. Neurology 52:1138–1145PubMed
17.
Zurück zum Zitat Claxton K, Neumann PJ, Araki S, Weinstein MC (2001) Bayesian value-of-information analysis: an application to a policy model of Alzheimer’s disease. Int J Technol Assess Health Care 17:38–55CrossRefPubMed Claxton K, Neumann PJ, Araki S, Weinstein MC (2001) Bayesian value-of-information analysis: an application to a policy model of Alzheimer’s disease. Int J Technol Assess Health Care 17:38–55CrossRefPubMed
18.
Zurück zum Zitat Morris JC (1993) The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 43:2412–2414 Morris JC (1993) The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 43:2412–2414
19.
Zurück zum Zitat Neumann PJ, Araki SS, Arcelus A, Longo A, Papadopoulos G, Kosik KS, Kuntz KM, Bhattacharjya A (2001) Measuring Alzheimer’s disease progression with transition probabilities. Estimates from CERAD. Neurology 57:957–964PubMed Neumann PJ, Araki SS, Arcelus A, Longo A, Papadopoulos G, Kosik KS, Kuntz KM, Bhattacharjya A (2001) Measuring Alzheimer’s disease progression with transition probabilities. Estimates from CERAD. Neurology 57:957–964PubMed
20.
Zurück zum Zitat Neumann PJ, Hermann RC, Weinstein MC (1998) Measuring QALYs in dementia. In: Wimo A, Jonsson B, Karlsson, Winblad B. (eds) Health economics in dementia. Wiley: Sussex, p 359–370 Neumann PJ, Hermann RC, Weinstein MC (1998) Measuring QALYs in dementia. In: Wimo A, Jonsson B, Karlsson, Winblad B. (eds) Health economics in dementia. Wiley: Sussex, p 359–370
21.
Zurück zum Zitat Dunkin JJ, Anderson-Hanley C (1998) Dementia caregiver burden: a review of the literature and guidelines for assessment and intervention. Neurology 51:S53–S63 Dunkin JJ, Anderson-Hanley C (1998) Dementia caregiver burden: a review of the literature and guidelines for assessment and intervention. Neurology 51:S53–S63
22.
Zurück zum Zitat Schultz R, Beach SR (1999) Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 282:2215–2219CrossRefPubMed Schultz R, Beach SR (1999) Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 282:2215–2219CrossRefPubMed
23.
Zurück zum Zitat Heikkinen K, Hujanen T, Rusama H (2001) Terveydenhuollon yksikkökustannukset Suomessa vuonna 2000. Aiheita 23. National Research and Development Centre for Welfare and Health Heikkinen K, Hujanen T, Rusama H (2001) Terveydenhuollon yksikkökustannukset Suomessa vuonna 2000. Aiheita 23. National Research and Development Centre for Welfare and Health
24.
Zurück zum Zitat Briggs A, Sculpher M, Buxton M (1994) Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 3:95–104PubMed Briggs A, Sculpher M, Buxton M (1994) Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 3:95–104PubMed
25.
Zurück zum Zitat Bland JM, Altman DG (1998) Bayesians and frequentists. BMJ 317:1151PubMed Bland JM, Altman DG (1998) Bayesians and frequentists. BMJ 317:1151PubMed
26.
Zurück zum Zitat Briggs AH (1999) A Bayesian approach to stochastic cost-effectiveness analysis. Health Econ 8:257–261CrossRefPubMed Briggs AH (1999) A Bayesian approach to stochastic cost-effectiveness analysis. Health Econ 8:257–261CrossRefPubMed
27.
Zurück zum Zitat Briggs AH (2000) Handling uncertainty in cost-effectiveness models. Pharmacoeconomics 17:479–500PubMed Briggs AH (2000) Handling uncertainty in cost-effectiveness models. Pharmacoeconomics 17:479–500PubMed
28.
Zurück zum Zitat Briggs AH, Goeree R, Blackhouse G, O’Brien BJ (2002) Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for gastroesophageal reflux disease. Med Decis Making 22:290–308CrossRefPubMed Briggs AH, Goeree R, Blackhouse G, O’Brien BJ (2002) Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for gastroesophageal reflux disease. Med Decis Making 22:290–308CrossRefPubMed
29.
Zurück zum Zitat Glick HA, Briggs AH, Polsky D (2001) Quantifying stochastic uncertainty and presenting results of cost-effectiveness analyses. Expert Rev. Pharmacoecon Outcomes Res 1:25–36 Glick HA, Briggs AH, Polsky D (2001) Quantifying stochastic uncertainty and presenting results of cost-effectiveness analyses. Expert Rev. Pharmacoecon Outcomes Res 1:25–36
30.
Zurück zum Zitat Stinnett AA, Mullahy J (1998) Net health benefits: a new framework for the analysis in cost-effectiveness analysis. Med Decis Making 18 [Suppl]:S68–S80 Stinnett AA, Mullahy J (1998) Net health benefits: a new framework for the analysis in cost-effectiveness analysis. Med Decis Making 18 [Suppl]:S68–S80
31.
Zurück zum Zitat Laska EM, Meisner M, Siegel C, Stinnett AA (1998) Ratio-based and net benefit-based approaches to health care resource allocation: proofs of optimality and equivalence. Health Econ 8:171–174CrossRef Laska EM, Meisner M, Siegel C, Stinnett AA (1998) Ratio-based and net benefit-based approaches to health care resource allocation: proofs of optimality and equivalence. Health Econ 8:171–174CrossRef
32.
Zurück zum Zitat Van Hout B, Al MJ, Gordon GS, Rutten FF (1994) Cost, effects and C/E-ratios alongside a clinical trial. Health Econ 3:309–319PubMed Van Hout B, Al MJ, Gordon GS, Rutten FF (1994) Cost, effects and C/E-ratios alongside a clinical trial. Health Econ 3:309–319PubMed
33.
Zurück zum Zitat Bell CM, Araki SS, Neumann PJ (2001) The association between caregivers burden and caregiver health-related quality of life in Alzheimer’s disease. Alzheimer Dis Assoc Disord 15:129–136CrossRefPubMed Bell CM, Araki SS, Neumann PJ (2001) The association between caregivers burden and caregiver health-related quality of life in Alzheimer’s disease. Alzheimer Dis Assoc Disord 15:129–136CrossRefPubMed
34.
Zurück zum Zitat Birks J, Grimley Evans J, Iakovidou V, Tsolaki M (2001) Rivastigmine for Alzheimer’s disease (Cochrane review). Cochrane Library 4 Birks J, Grimley Evans J, Iakovidou V, Tsolaki M (2001) Rivastigmine for Alzheimer’s disease (Cochrane review). Cochrane Library 4
35.
Zurück zum Zitat Dooley M, Lamb HM (2000) Donepezil: a review of its use in Alzheimer’s disease. Drugs Aging 16:199–226PubMed Dooley M, Lamb HM (2000) Donepezil: a review of its use in Alzheimer’s disease. Drugs Aging 16:199–226PubMed
36.
Zurück zum Zitat Olin J, Schneider L (2002) Galantamine for Alzheimer’s disease (Cochrane review). Cochrane Library, 1 Olin J, Schneider L (2002) Galantamine for Alzheimer’s disease (Cochrane review). Cochrane Library, 1
37.
Zurück zum Zitat Feldman H, Gauthier S, Hecker J, Vellas B, Subbiah P, Whalen E (2001) A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease. Neurology 57:613–620PubMed Feldman H, Gauthier S, Hecker J, Vellas B, Subbiah P, Whalen E (2001) A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease. Neurology 57:613–620PubMed
38.
Zurück zum Zitat Tariot PN, Solomon PR, Morris JC, Kershaw P, Lilienfeld S, Ding C (2000) A 5-month, randomized, placebo-controlled trial of galantamine in AD. Neurology 54:2269–2276PubMed Tariot PN, Solomon PR, Morris JC, Kershaw P, Lilienfeld S, Ding C (2000) A 5-month, randomized, placebo-controlled trial of galantamine in AD. Neurology 54:2269–2276PubMed
Metadaten
Titel
Potential cost-effectiveness of a family-based program in mild Alzheimer’s disease patients
verfasst von
Janne Martikainen
Hannu Valtonen
Tuula Pirttilä
Publikationsdatum
01.05.2004
Verlag
Springer-Verlag
Erschienen in
The European Journal of Health Economics / Ausgabe 2/2004
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-003-0214-1

Weitere Artikel der Ausgabe 2/2004

The European Journal of Health Economics 2/2004 Zur Ausgabe

Pricing and Reimbursement Systems

Pricing and reimbursement of drugs in Ireland