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

  • Janne Martikainen
  • Hannu Valtonen
  • Tuula Pirttilä
Original Papers

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.

Keywords

Alzheimer’s disease Family intervention Cost-effectiveness 

Notes

Acknowledgements

The authors thank the participants of Nordic Conference of Health Economists in Helsinki, Finland, August 2002 for their comments and encouragement and J. Joensuu, M.Sc, and Mrs. L. Silvasti for research assistance. Financial support from the Yrjö Jahnsson Foundation is gratefully acknowledged. Furthermore, the authors are grateful to two anonymous reviewers for their helpful comments.

References

  1. 1.
    Sulkava R, Wikström J, Aromaa A, Raitasalo R, Lehtinen V, Lahtela K, Palo J (1985) Prevalence of severe dementia in Finland. Neurology 35:1025–1029PubMedGoogle Scholar
  2. 2.
    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 262:2551–2556PubMedGoogle Scholar
  3. 3.
    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 42:115–119PubMedGoogle Scholar
  4. 4.
    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 328:153–158CrossRefPubMedGoogle Scholar
  5. 5.
    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 310:970–973PubMedGoogle Scholar
  6. 6.
    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 56:1690–1696PubMedGoogle Scholar
  7. 7.
    Wimo A, Ljunggren G, Winblad B (1997) Costs of dementia and dementia care–a review. Int J Geriatr Psychiatry 12:841–856CrossRefPubMedGoogle Scholar
  8. 8.
    Hu T, Huang L, Cartwright WS (1986) Evaluation of the costs of caring for the senile demented elderly: a pilot study. Gerontologist 26:158–163PubMedGoogle Scholar
  9. 9.
    Braak H, Braak E (1991) Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol (Berl) 82:239–259Google Scholar
  10. 10.
    Jost BC, Grossberg GT (1995) The natural history of Alzheimer’s disease: a brain bank study. J Am Geriatr Soc 43:1248–1255Google Scholar
  11. 11.
    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 47:166–177PubMedGoogle Scholar
  12. 12.
    Brodaty H, Gresham M, Luscombe G (1997) The Prince Henry Hospital dementia caregiver training program. Int J Geriatr Psychiatry 12:183–192CrossRefPubMedGoogle Scholar
  13. 13.
    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 49:1282–1287Google Scholar
  14. 14.
    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 276:1725–1731CrossRefPubMedGoogle Scholar
  15. 15.
    Stinnett AA, Paltiel AD (1997) Estimating CE ratios under second-order uncertainty: the mean ratio versus the ratio of means. Med Decis Making 17:483–489PubMedGoogle Scholar
  16. 16.
    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 52:1138–1145PubMedGoogle Scholar
  17. 17.
    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 17:38–55CrossRefPubMedGoogle Scholar
  18. 18.
    Morris JC (1993) The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 43:2412–2414Google Scholar
  19. 19.
    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 57:957–964PubMedGoogle Scholar
  20. 20.
    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 359–370Google Scholar
  21. 21.
    Dunkin JJ, Anderson-Hanley C (1998) Dementia caregiver burden: a review of the literature and guidelines for assessment and intervention. Neurology 51:S53–S63Google Scholar
  22. 22.
    Schultz R, Beach SR (1999) Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 282:2215–2219CrossRefPubMedGoogle Scholar
  23. 23.
    Heikkinen K, Hujanen T, Rusama H (2001) Terveydenhuollon yksikkökustannukset Suomessa vuonna 2000. Aiheita 23. National Research and Development Centre for Welfare and HealthGoogle Scholar
  24. 24.
    Briggs A, Sculpher M, Buxton M (1994) Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 3:95–104PubMedGoogle Scholar
  25. 25.
    Bland JM, Altman DG (1998) Bayesians and frequentists. BMJ 317:1151PubMedGoogle Scholar
  26. 26.
    Briggs AH (1999) A Bayesian approach to stochastic cost-effectiveness analysis. Health Econ 8:257–261CrossRefPubMedGoogle Scholar
  27. 27.
    Briggs AH (2000) Handling uncertainty in cost-effectiveness models. Pharmacoeconomics 17:479–500PubMedGoogle Scholar
  28. 28.
    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 22:290–308CrossRefPubMedGoogle Scholar
  29. 29.
    Glick HA, Briggs AH, Polsky D (2001) Quantifying stochastic uncertainty and presenting results of cost-effectiveness analyses. Expert Rev. Pharmacoecon Outcomes Res 1:25–36Google Scholar
  30. 30.
    Stinnett AA, Mullahy J (1998) Net health benefits: a new framework for the analysis in cost-effectiveness analysis. Med Decis Making 18 [Suppl]:S68–S80Google Scholar
  31. 31.
    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 8:171–174CrossRefGoogle Scholar
  32. 32.
    Van Hout B, Al MJ, Gordon GS, Rutten FF (1994) Cost, effects and C/E-ratios alongside a clinical trial. Health Econ 3:309–319PubMedGoogle Scholar
  33. 33.
    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 15:129–136CrossRefPubMedGoogle Scholar
  34. 34.
    Birks J, Grimley Evans J, Iakovidou V, Tsolaki M (2001) Rivastigmine for Alzheimer’s disease (Cochrane review). Cochrane Library 4Google Scholar
  35. 35.
    Dooley M, Lamb HM (2000) Donepezil: a review of its use in Alzheimer’s disease. Drugs Aging 16:199–226PubMedGoogle Scholar
  36. 36.
    Olin J, Schneider L (2002) Galantamine for Alzheimer’s disease (Cochrane review). Cochrane Library, 1Google Scholar
  37. 37.
    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 57:613–620PubMedGoogle Scholar
  38. 38.
    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 54:2269–2276PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Janne Martikainen
    • 1
    • 4
  • Hannu Valtonen
    • 2
  • Tuula Pirttilä
    • 3
  1. 1.Center for Pharmaceutical Policy and Economics, Department of Social PharmacyUniversity of KuopioFinland
  2. 2.Department of Health Policy and ManagementUniversity of KuopioFinland
  3. 3.Department of Neuroscience and NeurologyUniversity of KuopioFinland
  4. 4.Center for Pharmaceutical Policy and Economics, Department of Social PharmacyUniversity of KuopioKuopioFinland

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