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Lanctôt KL, Chen C, Mah E, Kiss A, Li A, Shade D, Scherer RW, Vieira D, Coulibaly H, Rosenberg PB, Lerner AJ, Padala PR, Brawman-Mintzer O, van Dyck CH, Porsteinsson AP, Craft S, Levey A, Burke WJ, Mintzer J, Herrmann N. Cost consequence analysis of Apathy in Dementia Methylphenidate Trial 2 (ADMET 2). Int Psychogeriatr 2023; 35:664-672. [PMID: 37066690 PMCID: PMC10579450 DOI: 10.1017/s1041610223000327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND This paper used data from the Apathy in Dementia Methylphenidate Trial 2 (NCT02346201) to conduct a planned cost consequence analysis to investigate whether treatment of apathy with methylphenidate is economically attractive. METHODS A total of 167 patients with clinically significant apathy randomized to either methylphenidate or placebo were included. The Resource Utilization in Dementia Lite instrument assessed resource utilization for the past 30 days and the EuroQol five dimension five level questionnaire assessed health utility at baseline, 3 months, and 6 months. Resources were converted to costs using standard sources and reported in 2021 USD. A repeated measures analysis of variance compared change in costs and utility over time between the treatment and placebo groups. A binary logistic regression was used to assess cost predictors. RESULTS Costs were not significantly different between groups whether the cost of methylphenidate was excluded (F(2,330) = 0.626, ηp2 = 0.004, p = 0.535) or included (F(2,330) = 0.629, ηp2 = 0.004, p = 0.534). Utility improved with methylphenidate treatment as there was a group by time interaction (F(2,330) = 7.525, ηp2 = 0.044, p < 0.001). DISCUSSION Results from this study indicated that there was no evidence for a difference in resource utilization costs between methylphenidate and placebo treatment. However, utility improved significantly over the 6-month follow-up period. These results can aid in decision-making to improve quality of life in patients with Alzheimer's disease while considering the burden on the healthcare system.
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Affiliation(s)
| | - Clara Chen
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Ethan Mah
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alex Kiss
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Abby Li
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Dave Shade
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roberta W. Scherer
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Hamadou Coulibaly
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Alan J. Lerner
- University Hospital – Case Western Reserve University, Cleveland, OH, USA
| | - Prasad R. Padala
- University of Arkansas for Medical Science, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Olga Brawman-Mintzer
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | | | | | - Suzanne Craft
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Jacobo Mintzer
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
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Profyri E, Leung P, Huntley J, Orgeta V. Effectiveness of treatments for people living with severe dementia: A systematic review and meta-analysis of randomised controlled clinical trials. Ageing Res Rev 2022; 82:101758. [PMID: 36243355 PMCID: PMC10580243 DOI: 10.1016/j.arr.2022.101758] [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: 06/23/2022] [Revised: 08/30/2022] [Accepted: 10/09/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dementia is a progressive neurodegenerative syndrome that has no cure. Although a significant proportion of people with dementia progress into the severe stages of the disease, evidence on the clinical effectiveness of treatments for people with severe dementia remains limited. AIMS To systematically review the effectiveness of pharmacological and non-pharmacological treatments for people living with severe dementia and assess the quality of the evidence. METHOD We searched MEDLINE, EMBASE, PsycINFO, CINAHL and online clinical trial registers up to January 2022, for Randomised Controlled Trials (RCT) in people living with severe dementia. Quality and risk of bias were assessed independently by two authors. RESULTS A total of 30 trials met our inclusion criteria of which 14 evaluated the effectiveness of pharmacological treatments, and 16 evaluated a non-pharmacological intervention. Pharmacological treatments: Meta-analyses indicated that pharmacological treatments (donepezil: 10 mg, 5 mg; galantamine: 24 mg; memantine: 10 mg) are associated with better outcomes compared to placebo for: severity of symptoms (standardized mean difference (SMD) 0.37, 95% CI 0.26-0.48; 4 studies; moderate-certainty evidence), activities of daily living (SMD 0.15, 95% CI 0.04-0.26; 5 studies; moderate-certainty evidence), and clinical impression of change (Relative Risk (RR) 1.34, 95% CI 1.14-1.57; 4 studies; low-certainty evidence). Pharmacological treatments were also more likely to reduce mortality compared to placebo (RR 0.60, 95% CI 0.40-0.89; 6 studies; low-certainty evidence). Non-pharmacological treatments: Five trials were included in the meta-analyses of non-pharmacological interventions (multi-sensory stimulation, needs assessment, and activities-based interventions); results showed that non-pharmacological interventions may reduce neuropsychiatric symptoms of dementia compared to usual care (SMD -0.33, 95% CI -0.59 to -0.06; low certainty evidence). CONCLUSIONS There is moderate-certainty evidence that pharmacological treatments may decrease disease severity and improve function for people with severe dementia. Non-pharmacological treatments are probably effective in reducing neuropsychiatric symptoms but the quality of evidence remains low. There is an urgent need for high-quality evidence for other outcomes and for developing service-user informed interventions for this under-served group.
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Ma WJ, He B, Wang YH, Huang W, Zhou J. Relationships between Kazakh elders' disability severity and informal care time in far north-western low-income areas in China: The mediating roles of caregiver health and home-based care quality. Int J Nurs Pract 2021; 28:e13022. [PMID: 34687110 DOI: 10.1111/ijn.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/02/2021] [Accepted: 09/24/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Elders' disability severity and caregiver health could predict elders' informal care time, but the mechanism by which the degree of disability in the elderly affects informal care time is unclear. AIM The aim of this works is to explore the mediating roles of caregiver health and home-based care quality between disability severity of elders and informal care time in far north-western low-income areas in China. METHOD From September 2017 to February 2018, three hundred fifty-two dyads of Kazakh disabled elders and informal caregivers in Xinjiang were interviewed. Structural equation modelling analyses were applied. RESULTS Significant positive correlations were observed between elders' disability severity and informal care time, caregiver health and informal care time, elders' disability severity and caregiver health. Significant negative correlations were observed between home-based care quality and informal care time, elders' disability severity and home-based care quality, caregiver health and home-based care quality. Elders' disability severity had 71.94% direct effect on informal care time, 28.06% indirect effect on informal care time mediated by home-based care quality and caregiver health. CONCLUSION Caregiver health and home-based care quality play mediating roles on the path relationship between the elders' disability severity and informal care time.
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Affiliation(s)
- Wen Juan Ma
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China College of Nursing, Sichuan University, Chengdu, China
| | - Bin He
- Department of joint surgery, The People's Hospital of Shihezi City, Shihezi, Xinjiang, China
| | - Yu Huan Wang
- Department of Medical Humanities, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Wei Huang
- Department of Medical Humanities, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Jia Zhou
- Department of Medical Humanities, Shihezi University School of Medicine, Shihezi, Xinjiang, China
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Gervais F, Dauphinot V, Mouchoux C, Krolak-Salmon P. Exposure to Anticholinergic and Sedative Drugs and Healthcare Costs in Older Patients with Neurocognitive Disorders. J Alzheimers Dis 2021; 80:1515-1524. [PMID: 33720884 DOI: 10.3233/jad-201127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Literature supports an increasing number of older patients living with neurocognitive disorders alongside with their annual worldwide costs. Therapeutic management of behavioral and psychological symptoms includes the use of anticholinergic and sedative drugs for which significant exposure is negatively associated with clinical outcomes. OBJECTIVE The aim of this study was to assess the healthcare costs differences related to an increase in the exposure to anticholinergic and sedative drugs in older patients with neurocognitive disorder. METHODS A longitudinal study was conducted during 3 years on 1,604 participants of the MEMORA cohort linked with both regional public health insurance and hospital discharge databases between 2012 and 2017. Direct medical and non-medical costs were included. Exposure to anticholinergic and sedative drugs was measured by the drug burden index (DBI). RESULTS Costs difference associated with a DBI≥0.5 were + 338€ (p < 0.001). After adjustment on comorbidities, NCD stage, cognitive impairment, functional limitation, polypharmacy, and sociodemographic characteristics, a DBI≥0.5 was found to be an independent predictor of an increase of total healthcare costs by 22%(p < 0.001). CONCLUSION Anticholinergic and sedative drugs have a substantial economic burden among older patients with neurocognitive disorder. More studies are required to assess the clinical and economic impact of an efficient strategy based on the reduction of the exposure to anticholinergic and sedative drugs and the promotion of non-pharmacological interventions.
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Affiliation(s)
- Frederic Gervais
- Pharmacie, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Virginie Dauphinot
- Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France
| | - Christelle Mouchoux
- Pharmacie, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France.,Research Clinic Centre (CRC)eVCF (Aging Brain Frailty), Lyon Institute For Elderly, Hospices civils de Lyon, Lyon, France.,University Lyon 1, INSERM, U1028, UMR CNRS, Research Centre of Neurosciences of Lyon, Lyon, France
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France.,Research Clinic Centre (CRC)eVCF (Aging Brain Frailty), Lyon Institute For Elderly, Hospices civils de Lyon, Lyon, France.,University Lyon 1, INSERM, U1028, UMR CNRS, Research Centre of Neurosciences of Lyon, Lyon, France
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El-Hayek YH, Wiley RE, Khoury CP, Daya RP, Ballard C, Evans AR, Karran M, Molinuevo JL, Norton M, Atri A. Tip of the Iceberg: Assessing the Global Socioeconomic Costs of Alzheimer's Disease and Related Dementias and Strategic Implications for Stakeholders. J Alzheimers Dis 2020; 70:323-341. [PMID: 31256142 PMCID: PMC6700654 DOI: 10.3233/jad-190426] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
While it is generally understood that Alzheimer’s disease (AD) and related dementias (ADRD) is one of the costliest diseases to society, there is widespread concern that researchers and policymakers are not comprehensively capturing and describing the full scope and magnitude of the socioeconomic burden of ADRD. This review aimed to 1) catalogue the different types of AD-related socioeconomic costs described in the literature; 2) assess the challenges and gaps of existing approaches to measuring these costs; and 3) analyze and discuss the implications for stakeholders including policymakers, healthcare systems, associations, advocacy groups, clinicians, and researchers looking to improve the ability to generate reliable data that can guide evidence-based decision making. A centrally emergent theme from this review is that it is challenging to gauge the true value of policies, programs, or interventions in the ADRD arena given the long-term, progressive nature of the disease, its insidious socioeconomic impact beyond the patient and the formal healthcare system, and the complexities and current deficiencies (in measures and real-world data) in accurately calculating the full costs to society. There is therefore an urgent need for all stakeholders to establish a common understanding of the challenges in evaluating the full cost of ADRD and define approaches that allow us to measure these costs more accurately, with a view to prioritizing evidence-based solutions to mitigate this looming public health crisis.
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Affiliation(s)
| | - Ryan E Wiley
- Shift Health, Toronto, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center, Barcelona, Spain.,Paqual Maragall Foundation, Barcelona, Spain
| | | | - Alireza Atri
- Banner Sun Health Research Institute, Banner Health, Sun City, AZ, USA.,Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Oliva-Moreno J, Peña-Longobardo LM, García-Mochón L, del Río Lozano M, Mosquera Metcalfe I, García-Calvente MDM. The economic value of time of informal care and its determinants (The CUIDARSE Study). PLoS One 2019; 14:e0217016. [PMID: 31112587 PMCID: PMC6529156 DOI: 10.1371/journal.pone.0217016] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/02/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The main aims of this paper are to analyse the monetary value of informal care time using different techniques and to identify significant variables associated with the number of caregiving hours. Data and methods A multicentre study in two Spanish regions in adult caregivers was conducted. A total sample of 604 people was available. A multivariate analysis was performed to identify the variables associated with the number of hours of caregiving time. In the monetary valuation of informal care provided, three approaches were used: replacement cost method, opportunity cost and contingent valuation (willingness to pay and willingness to accept). Results The main determinants of the amount of time of informal care provided were age, gender, the level of care receiver´s dependence and the professional care services received (at home and out of home). The value estimated for informal care time ranges from EUROS 80,247 (replacement cost method) to EUROS 14,325 (willingness to pay), with intermediate values of EUROS 27,140 and EUROS 29,343 (opportunity cost and willingness to accept, respectively). Several sensitivity analyses were performed over the base cases, confirming the previous results. Conclusions Time of informal care represents a great social value, regardless of the applied technique. However, the results can differ strongly depending on the technique chosen. Therefore, the choice of technique of valuation is not neutral. Among the determinants of informal care time, the professional care received at home has a complementary character to informal care, while the formal care outside the home has a substitute character.
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Affiliation(s)
- Juan Oliva-Moreno
- University of Castilla-La Mancha, Department of Economic Analysis and Seminar of Research on Economics and Health (SIES), Toledo, Spain
| | - Luz María Peña-Longobardo
- University of Castilla-La Mancha, Department of Economic Analysis and Seminar of Research on Economics and Health (SIES), Toledo, Spain
- * E-mail:
| | - Leticia García-Mochón
- Andalusian School of Public Health (EASP), Granada, Spain
- Biomedical Research Centre (ibs.GRANADA), Granada, Spain
| | - María del Río Lozano
- Andalusian School of Public Health (EASP), Granada, Spain
- Biomedical Research Centre (ibs.GRANADA), Granada, Spain
| | - Isabel Mosquera Metcalfe
- University of Basque Country, Department of Sociology and Research Group on social determinants of health and demographic change (OPIK), Gipuzkoa, Spain
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