Changing relative prevalence of Alzheimer disease versus non-Alzheimer disease dementias: have we underestimated the looming dementia epidemic?

Post-market utilization patterns of Alzheimer's disease treatments in South Korea: comparison with countries with universal health coverage

PURPOSE

This study aimed to compare the utilization of Alzheimer's disease (AD) treatments, donepezil, galantamine, rivastigmine, and memantine, in Korea with Australia and other countries with universal health coverage.

METHODS

Reimbursement criteria and the patent status of four AD treatments in Korea and Australia were reviewed. The monthly spending and utilization of the treatments were extracted from the national electronic database in Korea and Australia. The defined daily dose per 1000 elderly population per day (DDD/1000e/day) were calculated from July 2008 to June 2019. Annual cost trends of Norway and England were compared with Korea and Australia.

RESULTS

With the highest share of the use of donepezil in both countries, the cost and utilization of AD treatments in Korea increased more rapidly and remained higher than Australia. The cost of AD treatments in Korea increased by 15.5% every year during the study period, while the spending of the same drugs in Australia decreased by 10.5% annually. The utilization in DDD/1000e/day of AD treatments in Korea increased by 18.3% annually compared with 1.4% in Australia. When compared with Norway and England, countries with similar universal health coverage (UHC) system and elderly polupation, the cost of AD treatments in Korea was still higher with the opposite trend from other countries.

CONCLUSIONS

Despite the similar UHC systems, there were considerable differences in the post-market utilization of AD treatments in Korea from Australia and other countries. This results can be attributed to differences in re-assessment system, pricing and reimbursement policies, and prescribing culture. This study provides a baseline to explore more comprehensive cross-country studies on rational use of medicines.

Coated-platelet levels and progression from mild cognitive impairment to Alzheimer disease

OBJECTIVES

Coated-platelets are a subset of platelets produced by dual-agonist activation with collagen and thrombin. These platelets retain full-length amyloid precursor protein on their surface, are elevated in patients with amnestic as compared to nonamnestic mild cognitive impairment (MCI), and correlate with disease progression in Alzheimer disease (AD). Prompted by these findings, we investigated the association between coated-platelet production in amnestic MCI and rate of progression to AD.

METHODS

Coated-platelet levels were assayed in 74 patients with amnestic MCI who were subsequently followed longitudinally for up to 36 months in an outpatient dementia clinic. Levels are reported as percent of cells converted into coated-platelets. Subjects were categorized into tertiles of coated-platelet levels. The distributions of time to progression to AD were estimated for each tertile using cumulative incidence curves and compared statistically using a log-rank test. Cox proportional hazards regression was used to adjust for potential confounders.

RESULTS

The 24-month cumulative incidence of progression to AD was different among tertiles: 4% for the first tertile (lowest coated-platelet levels), 13% for the second tertile, and 37% for the third tertile (overall log-rank test, p = 0.02). The hazard rate of progression to AD for patients in the highest coated-platelet tertile was 5.1 times that for patients in the lowest tertile (p = 0.04), whereas the hazard rate for the middle tertile was similar to that for the lowest tertile (hazard rate ratio = 1.5, p = 0.7).

CONCLUSIONS

Elevated coated-platelet levels in patients with amnestic MCI are associated with increased risk for progression to AD.

Differences in coated-platelet production between frontotemporal dementia and Alzheimer disease

OBJECTIVE

Coated-platelets are a subset of platelets produced by dual-agonist activation with collagen and thrombin. These platelets retain full-length amyloid precursor protein on their surface and correlate inversely with disease severity in Alzheimer disease (AD). We have now investigated coated-platelet production and its relationship with disease severity in frontotemporal dementia (FTD) patients to determine whether our earlier observations were unique to AD.

METHODS

Coated-platelet levels were assayed in 40 FTD, 40 AD patients, and 40 controls. Both patient groups were equally divided between mild-stage (Clinical Dementia Rating < or =1) and advanced stage dementia (Clinical Dementia Rating >1).

RESULTS

Coated-platelet levels were not significantly different between patients with early-stage and advanced stage FTD (P=0.9), whereas early-stage AD patients had significantly higher levels than advanced stage AD (P<0.001). In addition, coated-platelet production was significantly elevated in early-stage AD versus early-stage FTD patients (P=0.01).

CONCLUSIONS

In contrast to AD, there is no significant relationship between disease severity and coated-platelet levels in FTD. Differences in coated-platelet levels between early-stage AD and early-stage FTD patients warrant further investigation for potential clinical applications in helping to differentiate between these 2 disorders.

Israeli lay persons' views on priority-setting criteria for Alzheimer's disease

AIM

The aim of this study was to assess Israeli lay persons' preferences for setting priorities for the care of Alzheimer's disease (AD).

BACKGROUND

As the knowledge about AD accumulates, and especially as more therapeutic and non-therapeutic interventions for its early diagnosis and treatment are developed, health-care costs associated with the disease rise dramatically. Therefore, setting priorities for funding these therapies, as well as other costs associated with AD is becoming an increasingly complex need.

METHODS

A convenience sample of 624 community-dwelling men and women participated in the study (mean age = 49, range = 20-90). Participants were asked how strongly they agreed or disagreed with 18 criteria that would be used to set priorities for the allocation of resources in the area of AD.

RESULTS

High-weight criteria included being a life-threatening condition and the benefit of treatment. Average-weight criteria included the severity of the disease, treatment costs and equity of access. The age of the patient also was highly rated. All other patient-related criteria were rated as low. Value orientations and education were the main variables associated with participants' preferences.

CONCLUSIONS

The lay public seems to endorse a multi-criteria decision process for the allocation of resources in the area of AD. Similar to other diseases--disease-related criteria were highly preferred. These preferences should be compared with those of other stakeholders such as clinicians and policy makers.