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Lastuka A, Bliss E, Breshock MR, Iannucci VC, Sogge W, Taylor KV, Pedroza P, Dieleman JL. Societal Costs of Dementia: 204 Countries, 2000-2019. J Alzheimers Dis 2024:JAD240163. [PMID: 39150827 DOI: 10.3233/jad-240163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
Background Dementia prevalence is expected to increase as populations grow and age. Therefore, additional resources will be needed to meet the global demand for care for Alzheimer's disease and related dementias (ADRD). Objective Estimate global and country-level health care spending attributable to ADRD and the cost of informal care for people living with ADRD. Methods We gathered data from three systematic literature reviews and the Global Burden of Disease 2019 study. We used spatiotemporal Gaussian process regression to impute estimates for the many countries without underlying data. We projected future costs to 2050 based on past trends in costs, diagnosis rates, and institutionalization rate. Results We estimated that in 2019, the direct health care spending attributable to ADRD across 204 countries reached $260.6 billion (95% uncertainty interval [UI] 131.6-420.4) and the cost of informal ADRD care was $354.1 billion (95% UI 190.0-544.1). On average, informal care represents 57% (95% UI 38-75%) of the total cost of care. We estimated that direct health care spending attributable to ADRD will reach $1.6 trillion (95% UI 0.6-3.3) in 2050, or 9.4% (95% UI 3.9-19.6%) of projected health spending worldwide. We estimated the cost of informal care will reach $0.9 trillion (95% UI 0.3-1.7) in 2050. Conclusions These cost estimates underscore the magnitude of resources needed to ensure sufficient resources for people living with ADRD and highlight the role that informal care plays in provision of their care. Incorporating informal care cost estimates is critical to capture the social cost of ADRD.
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Affiliation(s)
- Amy Lastuka
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Elye Bliss
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael R Breshock
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vincent C Iannucci
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - William Sogge
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kayla V Taylor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Paola Pedroza
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Raket LL, Cummings J, Moscoso A, Villain N, Schöll M. Scenarios for the long-term efficacy of amyloid-targeting therapies in the context of the natural history of Alzheimer's disease. Alzheimers Dement 2024. [PMID: 39073291 DOI: 10.1002/alz.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Recent clinical trials of amyloid beta (Aβ)-targeting therapies in Alzheimer's disease (AD) have demonstrated a clinical benefit over 18 months, but their long-term impact on disease trajectory is not yet understood. We propose a framework for evaluating realistic long-term scenarios. METHODS Results from recent phase 3 trials of Aβ-targeting antibodies were integrated with an estimate of the long-term patient-level natural history trajectory of the Clinical Dementia Rating-Sum of Boxes (CDR-SB) score to explore realistic long-term efficacy scenarios. RESULTS Three distinct long-term efficacy scenarios were examined, ranging from conservative to optimistic. These extrapolations of positive phase 3 trials suggested treatments delayed onset of severe dementia by 0.3 to 0.6 years (conservative), 1.1 to 1.9 years (intermediate), and 2.0 to 4.2 years (optimistic). DISCUSSION Our study provides a common language for long-term impact of disease-modifying treatments. Our work calls for studies with longer follow-up and results from early intervention trials to provide a comprehensive assessment of these therapies' true long-term impact. HIGHLIGHTS We present long-term scenarios of the efficacy of AD therapies. In this framework, scenarios are defined relative to the natural history of AD. Long-term projections with different levels of optimism can be compared. It provides a common language for expressing beliefs about long-term efficacy.
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Affiliation(s)
- Lars Lau Raket
- Eli Lilly and Company, Indianapolis, Indiana, USA
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, Nevada, USA
| | - Alexis Moscoso
- Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Huvudbyggnad Vasaparken, Universitetsplatsen 1, Gothenburg, Sweden
| | - Nicolas Villain
- Department of Neurology, Institute of Memory and Alzheimer's Disease, AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, INSERM U1127, Institut du Cerveau - ICM, Paris, France
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Huvudbyggnad Vasaparken, Universitetsplatsen 1, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, London, UK
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Mattke S, Ozawa T, Hanson M. Implications of treatment duration and frequency for value and cost-effective price of Alzheimer treatments. J Manag Care Spec Pharm 2024:1-8. [PMID: 39037747 DOI: 10.18553/jmcp.2024.24116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
BACKGROUND Disease-modifying Alzheimer treatments are becoming available. The value of the treatments will be attenuated by their complexity of delivery and monitoring, creating additional medical cost and caregiver burden. OBJECTIVE To estimate net treatment value using different assumptions for treatment duration and intensity. METHODS We estimated the lifetime value of hypothetical treatments that reduce disease progression by 30% from a payer perspective, which considers cost offsets, i.e., reduced medical and formal social care costs, and quality-adjusted life-year gains, and a societal perspective, which adds reduction in caregiver burden. Estimates for gross value of the treatment were based on a prior publication, medical cost on Medicare payment rates, and caregiver time use on a survey of 21 clinics. We analyzed 5 hypothetical treatment scenarios: treatment until progression to moderate dementia with (1) biweekly and (2) 4-weekly infusions, and time-limited infusions every 4 weeks for (3) 72, (4) 52, and (5) 24 weeks. RESULTS Treatment until progression to moderate dementia would take 5.7 years and generate gross value of $20,734 in direct cost offsets, $83,761 from a payer and $87,749 from a societal perspective, respectively. Added medical cost and caregiver burden for the 5 scenarios would be $44,179, $24,875, $21,632, $20,416, and $14,350, respectively. The maximum value-based price per year would be $7,687, $11,088, $47,708, $67,273, and $158,954. CONCLUSIONS Assuming identical efficacy and safety, the net value generation of time-limited treatment is projected to be larger than that of chronic treatment. Such determination of net lifetime value can be useful to determine value-based prices for different treatment types.
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Affiliation(s)
- Soeren Mattke
- The USC Brain Health Observatory, Center for Economic and Social Research, University of Southern California, Los Angeles
| | - Tabasa Ozawa
- The USC Brain Health Observatory, Center for Economic and Social Research, University of Southern California, Los Angeles
| | - Mark Hanson
- The USC Brain Health Observatory, Center for Economic and Social Research, University of Southern California, Los Angeles
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Lastuka A, Breshock MR, McHugh TA, Sogge WT, Swart V, Dieleman JL. U.S. dementia care spending by state: 2010-2019. Alzheimers Dement 2024; 20:2742-2751. [PMID: 38411287 PMCID: PMC11032574 DOI: 10.1002/alz.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Dementia is the fourth largest cause of death for individuals 70 years of age and older in the United States, and it is tremendously costly. Existing estimates of the indirect costs of dementia are dated and do not report on differences across the United States. METHODS We used data from multiple surveys to create cost estimates and projections for informal dementia caregiving at the U.S. state level from 2010 through 2050. RESULTS In 2019, the annual replacement cost of informal caregiving was $42,422 per prevalent case, and the forgone wage cost was $10,677 per prevalent case. In 2019, it would have cost $230 billion to hire home health aides to provide all this care. If past trends persist, this cost is expected to grow to $404 billion per year in 2050. DISCUSSION The cost of informal care varied substantially by state and is expected to grow through at least 2050. HIGHLIGHTS In the United States in 2019, foregone wages due to informal dementia care was $58 billion. Replacing informal dementia care with health aides would have cost $230 billion. These costs vary dramatically by state, even when assessed per prevalent case. These costs are expected to nearly double by 2050.
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Affiliation(s)
- Amy Lastuka
- Institute for Health Metrics and EvaluationUniversity of WashingtonSeattleWashingtonUSA
| | - Michael R. Breshock
- Institute for Health Metrics and EvaluationUniversity of WashingtonSeattleWashingtonUSA
| | - Theresa A. McHugh
- Institute for Health Metrics and EvaluationUniversity of WashingtonSeattleWashingtonUSA
| | - William T. Sogge
- Institute for Health Metrics and EvaluationUniversity of WashingtonSeattleWashingtonUSA
| | - Vivianne Swart
- Institute for Health Metrics and EvaluationUniversity of WashingtonSeattleWashingtonUSA
| | - Joseph L. Dieleman
- Institute for Health Metrics and EvaluationUniversity of WashingtonSeattleWashingtonUSA
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Jun H, Mattke S, Chen A, Aguila E. The Value of Medicare Coverage on Depressive Symptoms Among Older Immigrants. THE GERONTOLOGIST 2024; 64:gnad070. [PMID: 37330627 PMCID: PMC10825837 DOI: 10.1093/geront/gnad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The immigrant population, the primary driver of U.S. population growth, is aging and many immigrants remain uninsured. Lack of health insurance limits access to care, aggravating the already high level of depression for older immigrants. However, there is scarce evidence on how health insurance, particularly Medicare, affects their mental health. Using the Health and Retirement Study, this study examines the effect of Medicare coverage on depressive symptoms of older immigrants in the United States. RESEARCH DESIGN AND METHODS Exploiting the fact that many immigrants are not covered by Medicare after passing age 65, we use a difference-in-difference model with propensity score weighting to compare differences in depressive symptoms pre- and post-age-65. We further stratify the sample by socioeconomic status and by race/ethnicity. RESULTS Medicare coverage was significantly associated with a reduction in the probability of reporting depressive symptoms for immigrants with low socioeconomic status, especially for those below median wealth levels. The beneficial effect of Medicare coverage was also statistically significant for non-White immigrants-Black, Hispanic, and Asian/Pacific Islander-even when holding socioeconomic status constant. DISCUSSION AND IMPLICATIONS Our findings imply that immigration policies that expand health care protection to older immigrants can lead to further health benefits and reduce existing disparities for the aging population. Policy reforms such as providing limited Medicare access to immigrants who paid sufficient taxes but are still awaiting permanent residency status could increase coverage for the uninsured and improve participation of immigrants in the payroll system.
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Affiliation(s)
- Hankyung Jun
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Soeren Mattke
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Alice Chen
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Emma Aguila
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
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Spargo D, Zur R, Lin P, Synnott P, Klein E, Hartry A. Estimating prevalence of early symptomatic Alzheimer's disease in the United States. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12497. [PMID: 38034853 PMCID: PMC10682565 DOI: 10.1002/dad2.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Understanding the prevalence of treatment-eligible Alzheimer's disease (AD) is crucial for policy planning. METHODS We used a comprehensive literature review and population cascade approach to estimate the number of amyloid-positive, clinically diagnosed patients with mild cognitive impairment (MCI) or mild dementia due to AD in the United States. RESULTS An estimated 666,646 individuals were identified as having MCI due to AD (range: 351,926-1,227,776) and 620,850 individuals as having mild dementia due to AD (range: 445,082-820,339). In a US population of 76 million individuals aged 60 or older in 2021, the estimates of MCI and mild dementia due to AD increased with age. CONCLUSIONS As earlier diagnosis of AD and new disease-modifying treatments become available, accurate population estimates are required to reduce uncertainty in the number of clinically diagnosed patients eligible for amyloid-targeting therapies.
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Affiliation(s)
| | | | - Pei‐Jung Lin
- Center for the Evaluation of Value and Risk in HealthInstitute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMassachusettsUSA
| | - Patricia Synnott
- Center for the Evaluation of Value and Risk in HealthInstitute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMassachusettsUSA
| | - Eric Klein
- Eli Lilly and CompanyIndianapolisIndianaUSA
| | - Ann Hartry
- Eli Lilly and CompanyIndianapolisIndianaUSA
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Takechi H, Yoshino H. Health Care Resource Use and Social Costs in Mild Cognitive Impairment and Mild Alzheimer's Disease. J Alzheimers Dis Rep 2023; 7:731-738. [PMID: 37483328 PMCID: PMC10357114 DOI: 10.3233/adr-230032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Background As the number of patients with dementia increases, so do the social costs. In recent years, attempts have been made to reduce risk to be dementia and treat it from the early stages of the disease, making it important to estimate the costs of the early stages. Objective To estimate the medical and social costs of the early stages of Alzheimer's disease (AD), which include mild cognitive impairment (MCI) due to AD and mild AD. Methods Questionnaires were used to obtain basic information (e.g., age, cognitive function) and medical costs, social care costs, family caregiver medical costs, and family caregiver informal care costs from patients with MCI due to AD or mild AD who were attending a memory clinic. A comparison was then conducted between these two groups. Results Patients with mild AD had higher total costs, patient medical costs, patient social care costs, and family caregiver informal care costs than did patients with MCI; however, only patient medical costs were significantly different (p = 0.022). A detailed analysis of patient medical costs revealed that anti-dementia drug treatment costs were significantly higher in patients with mild AD (p < 0.001). Conclusion Compared with patients with mild AD, those with MCI may have lower patient and family caregiver costs. As it is important to reduce social costs through risk reduction and therapeutic interventions from the early stages of AD, the present findings could help estimate the social costs and verify the cost-effectiveness of early interventions for AD.
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Affiliation(s)
- Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hiroshi Yoshino
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Takami A, Kato M, Deguchi H, Igarashi A. Value elements and methods of value-based pricing for drugs in Japan: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:749-759. [PMID: 37339436 DOI: 10.1080/14737167.2023.2223984] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Value-based pricing (VBP) can be a promising tool for optimizing drug prices. However, there is no consensus on the specific value elements and pricing method that should be used for VBP. AREAS COVERED We performed a systematic review and narrative synthesis to investigate the value elements and pricing method for VBP. The main inclusion criterion was that value elements, VBP method, and estimated prices for actual drugs were reported. We performed a search in MEDLINE and ICHUSHI Web. Eight articles met the selection criteria. Four studies adopted the cost-effectiveness analysis (CEA) approach and the others used different approaches. The CEA approach included the value elements of productivity, value of hope, real option value, disease severity, insurance value in addition to costs and quality-adjusted life years. The other approaches used efficacy, toxicity, novelty, rarity, research and development costs, prognosis, population health burden, unmet needs, and effectiveness. Each study used individual methods to quantify these broader value elements. EXPERT OPINION Both conventional and broader value elements are used for VBP. To allow VBP to be widely applied to various diseases, a simple, versatile method is preferable. Further research is needed to establish VBP method which enables to incorporate broader values.
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Affiliation(s)
- Akina Takami
- Market Access, Public Affairs & Patient Experience, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Masafumi Kato
- Market Access, Public Affairs & Patient Experience, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Hisato Deguchi
- Market Access, Public Affairs & Patient Experience, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
- Department of Public Health, School of Medicine, Yokohama City University, Yokohama, Japan
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Ford E, Milne R, Curlewis K. Ethical issues when using digital biomarkers and artificial intelligence for the early detection of dementia. WILEY INTERDISCIPLINARY REVIEWS. DATA MINING AND KNOWLEDGE DISCOVERY 2023; 13:e1492. [PMID: 38439952 PMCID: PMC10909482 DOI: 10.1002/widm.1492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 03/06/2024]
Abstract
Dementia poses a growing challenge for health services but remains stigmatized and under-recognized. Digital technologies to aid the earlier detection of dementia are approaching market. These include traditional cognitive screening tools presented on mobile devices, smartphone native applications, passive data collection from wearable, in-home and in-car sensors, as well as machine learning techniques applied to clinic and imaging data. It has been suggested that earlier detection and diagnosis may help patients plan for their future, achieve a better quality of life, and access clinical trials and possible future disease modifying treatments. In this review, we explore whether digital tools for the early detection of dementia can or should be deployed, by assessing them against the principles of ethical screening programs. We conclude that while the importance of dementia as a health problem is unquestionable, significant challenges remain. There is no available treatment which improves the prognosis of diagnosed disease. Progression from early-stage disease to dementia is neither given nor currently predictable. Available technologies are generally not both minimally invasive and highly accurate. Digital deployment risks exacerbating health inequalities due to biased training data and inequity in digital access. Finally, the acceptability of early dementia detection is not established, and resources would be needed to ensure follow-up and support for those flagged by any new system. We conclude that early dementia detection deployed at scale via digital technologies does not meet standards for a screening program and we offer recommendations for moving toward an ethical mode of implementation. This article is categorized under:Application Areas > Health CareCommercial, Legal, and Ethical Issues > Ethical ConsiderationsTechnologies > Artificial Intelligence.
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Affiliation(s)
- Elizabeth Ford
- Department of Primary Care and Public HealthBrighton and Sussex Medical SchoolBrightonUK
| | - Richard Milne
- Kavli Centre for Ethics, Science and the PublicUniversity of CambridgeCambridgeUK
- Engagement and SocietyWellcome Connecting ScienceCambridgeUK
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Frederiksen KS, Lanctôt KL, Weidner W, Hahn-Pedersen JH, Mattke S. A Literature Review on the Burden of Alzheimer's Disease on Care Partners. J Alzheimers Dis 2023; 96:947-966. [PMID: 37980660 DOI: 10.3233/jad-230487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Many individuals with Alzheimer's disease (AD) are dependent on nonprofessional care partners. Providing informal care can result in emotional, physical, and financial burdens; however, there is a need for a better understanding of the impact of AD on care partners to support the clinical and economic assessment of potential new treatments. OBJECTIVE We conducted a literature review to evaluate the burden experienced by care partners of individuals with AD. METHODS Electronic screening and supplementary searches identified studies published from 2011 to 2022 describing the association between AD and the quality of life (QoL) and physical health of care partners, and the economic or financial burden of AD. RESULTS Following electronic screening, 62, 25, and 39 studies were included on care partner burden, cost, and healthcare resource use in AD, respectively. Supplementary searches identified an additional 32 studies, resulting in 149 unique studies. These studies showed that care partners of individuals with AD report moderate to severe burden. Higher burden and lower QoL were observed in those caring for individuals with more severe AD. Care partners of individuals with AD experience higher burden, lower QoL, and higher levels of stress, depression, and anxiety than those without caring responsibilities. Informal care costs increased with AD severity and accounted for the greatest proportion of overall societal cost. CONCLUSIONS Care partners of individuals with AD experience emotional and economic burden, which increases with AD severity. These impacts should be quantified comprehensively in future studies and captured in economic evaluations of AD interventions.
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Affiliation(s)
- Kristian Steen Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | - Soeren Mattke
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, US
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Moebius HJ, Church KJ. The Case for a Novel Therapeutic Approach to Dementia: Small Molecule Hepatocyte Growth Factor (HGF/MET) Positive Modulators. J Alzheimers Dis 2023; 92:1-12. [PMID: 36683507 PMCID: PMC10041442 DOI: 10.3233/jad-220871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
An estimated 6.5 million Americans aged 65 years or older have Alzheimer's disease (AD), which will grow to 13.8 million Americans by 2060. Despite the growing burden of dementia, no fundamental change in drug development for AD has been seen in > 20 years. Currently approved drugs for AD produce only modest symptomatic improvements in cognition with small effect sizes. A growing mismatch exists between the urgent need to develop effective drugs for symptomatic AD and the largely failed search for disease modification. The failure rate of clinical trials in AD is high overall, and in particular for disease-modifying therapies. Research efforts in AD have focused predominantly on amyloid-β and tau pathologies, but limiting clinical research to these "classical hallmarks" of the disease does not address the most urgent patient, caregiver, or societal needs. Rather, clinical research should consider the complex pathophysiology of AD. Innovative approaches are needed that provide outside-the-box thinking, and re-imagine trial design, interventions, and outcomes as well as progress in proteomics and fluid biomarker analytics for both diagnostics and disease monitoring. A new approach offering a highly specific, yet multi-pronged intervention that exerts positive modulation on the HGF/MET neurotrophic system is currently being tested in mid-to-late-stage clinical trials in mild to moderate AD. Findings from such trials may provide data to support novel approaches for development of innovative drugs for treating AD at various disease stages, including among patients already symptomatic, and may offer benefits for other neurodegenerative diseases.
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Ball DE, Mattke S, Frank L, Murray JF, Noritake R, MacLeod T, Benham‐Hermetz S, Kurzman A, Ferrell P. A framework for addressing Alzheimer's disease: Without a frame, the work has no aim. Alzheimers Dement 2022; 19:1568-1578. [PMID: 36478657 DOI: 10.1002/alz.12869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022]
Abstract
Confronting Alzheimer's disease (AD) involves patients, healthcare professionals, supportive services, caregivers, and government agencies interacting along a continuum from initial awareness to diagnosis, treatment, support, and care. This complex scope presents a challenge for health system transformation supporting individuals at risk for, or diagnosed with, AD. The AD systems preparedness framework was developed to help health systems identify specific opportunities to implement and evaluate focused improvement programs. The framework is purposely flexible to permit local adaptation across different health systems and countries. Health systems can develop solutions tailored to system-specific priorities considered within the context of the overall framework. Example metric concepts and initiatives are provided for each of ten areas of focus. Examples of funded projects focusing on screening and early detection are provided. It is our hope that stakeholders utilize the common framework to generate and share additional implementation evidence to benefit individuals with AD.
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Affiliation(s)
- Daniel E. Ball
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
| | - Soeren Mattke
- Center for Economic and Social Research University of Southern California Los Angeles California USA
| | - Lori Frank
- The New York Academy of Medicine New York New York USA
| | - James F. Murray
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
| | - Ryoji Noritake
- Health and Global Policy Institute, Grand Cube 3F, Otemachi Financial City Global Business Hub Tokyo Tokyo Japan
| | - Timothy MacLeod
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
- Bridgeable Toronto Ontario USA
| | | | - Alissa Kurzman
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
- High Lantern Group Philadelphia Pennsylvania USA
- World Economic Forum New York New York USA
| | - Phyllis Ferrell
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
- Eli Lilly and Company Lilly Corporate Center Indianapolis Indiana USA
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Boustani M, Doty EG, Garrison LP, Smolen LJ, Belger M, Klein TM, Murphy DR, Burge R, Wall J, Johnston JA. Assessing the Cost-effectiveness of a Hypothetical Disease-Modifying Therapy With Limited Duration for the Treatment of Early Symptomatic Alzheimer Disease. Clin Ther 2022; 44:1449-1462. [DOI: 10.1016/j.clinthera.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/07/2022] [Indexed: 11/03/2022]
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14
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Schindler SE, Li Y, Li M, Despotis A, Park E, Vittert L, Hamilton BH, Womack KB, Saef B, Holtzman DM, Morris JC, Bateman RJ, Gupta MR. Using Alzheimer's disease blood tests to accelerate clinical trial enrollment. Alzheimers Dement 2022; 19:1175-1183. [PMID: 35934777 PMCID: PMC9902574 DOI: 10.1002/alz.12754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/03/2022] [Accepted: 06/22/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Screening potential participants in Alzheimer's disease (AD) clinical trials with amyloid positron emission tomography (PET) is often time consuming and expensive. METHODS A web-based application was developed to model the time and financial cost of screening for AD clinical trials. Four screening approaches were compared; three approaches included an AD blood test at different stages of the screening process. RESULTS The traditional screening approach using only amyloid PET was the most time consuming and expensive. Incorporating an AD blood test at any point in the screening process decreased both the time and financial cost of trial enrollment. Improvements in AD blood test accuracy over currently available tests only marginally increased savings. Use of a high specificity cut-off may improve the feasibility of screening with only an AD blood test. DISCUSSION Incorporating AD blood tests into screening for AD clinical trials may reduce the time and financial cost of enrollment. HIGHLIGHTS The time and cost of enrolling participants in Alzheimer's disease (AD) clinical trials were modeled. A web-based application was developed to enable evaluation of key parameters. AD blood tests may decrease the time and financial cost of clinical trial enrollment. Improvements in AD blood test accuracy only marginally increased savings. Use of a high specificity cut-off may enable screening with only an AD blood test.
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Affiliation(s)
- Suzanne E. Schindler
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, 63110, USA,Corresponding author: Suzanne E. Schindler, MD, PhD, Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110, USA. Phone (314) 273-1655, Fax (314) 362-2244
| | - Yan Li
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Melody Li
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Alyssa Despotis
- Olin Business School, Washington University, St. Louis, MO, USA
| | - Ethan Park
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Liberty Vittert
- Olin Business School, Washington University, St. Louis, MO, USA
| | | | - Kyle B. Womack
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Benjamin Saef
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - David M. Holtzman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, 63110, USA,Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - John C. Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Randall J. Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, 63110, USA,Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, 63110, USA
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