Green Colin
Institute for Health Service Research, Peninsula Medical School, University of Exeter, Exeter, UK.
Pharmacoeconomics. 2007;25(9):735-50. doi: 10.2165/00019053-200725090-00003.
The literature reporting economic evaluations related to the treatment of Alzheimer's disease (AD) has developed over the last decade. Most analyses have used economic models to estimate the cost effectiveness of drugs for the treatment of AD. This review considers the range of methods used in the published cost-effectiveness literature to model AD progression and the effect of interventions on the progression of AD. The review builds on and updates an earlier systematic review of cost-effectiveness studies on drugs for AD. Systematic and rigorous methods were used to search the literature for economic evaluations estimating the cost effectiveness of donepezil, rivastigmine, galantamine or memantine in AD. The literature search covered a wide range of electronic databases (e.g. MEDLINE, EMBASE), and included literature from the inception of databases up to the end of 2005. The search identified 22 published economic evaluations. An outline and brief critical review of the identified studies is provided, and thereafter the methods used to model disease progression were considered in more detail. The review employs recent guidance on good practice in decision-analytic modelling in HTA to critically review the modelling methods used. Using this guidance, the models are assessed against the broad criteria of model structure, data inputs and assessment of uncertainty and inconsistency. Concerns were noted over the model structure employed in all models. The reliance on cognitive scores to model AD, the progression of the disease, and the effect of treatment on costs and consequences is regarded as a serious limitation in almost all of the studies identified. There are also limitations over the data used to populate published models, especially around the failure of studies to document and establish the basis for the modelling of treatment effects. It is also clear that studies modelling AD progression, and subsequently the cost effectiveness of treatment, have not addressed uncertainty or consistency (internal and/or external) in sufficient detail. Further research is required on more appropriate methods for the modelling of AD progression. In the meantime, future economic evaluations of treatment need to be more explicit on the methods used to model AD, and the data used to populate models.
过去十年间，有关阿尔茨海默病（AD）治疗的经济评估文献不断涌现。多数分析采用经济模型来估算治疗AD药物的成本效益。本综述探讨了已发表的成本效益文献中用于模拟AD病情进展以及干预措施对AD病情进展影响的一系列方法。该综述以先前对AD药物成本效益研究的系统综述为基础并进行了更新。我们运用系统且严谨的方法在文献中检索估算多奈哌齐、卡巴拉汀、加兰他敏或美金刚治疗AD成本效益的经济评估。文献检索涵盖了广泛的电子数据库（如MEDLINE、EMBASE），包括从数据库建立之初到2005年底的文献。检索共识别出22篇已发表的经济评估。我们提供了所识别研究的概述和简要批判性综述，随后更详细地探讨了用于模拟疾病进展的方法。本综述采用了卫生技术评估中决策分析建模良好实践的最新指南，对所使用的建模方法进行批判性审查。依据该指南，从模型结构、数据输入以及不确定性和不一致性评估等广泛标准对模型进行评估。所有模型所采用的模型结构均存在问题。几乎在所有已识别的研究中，依赖认知评分来模拟AD、疾病进展以及治疗对成本和后果的影响都被视为一个严重的局限性。用于填充已发表模型的数据也存在局限性，尤其是研究未能记录和确立治疗效果建模的依据。同样明显的是，模拟AD进展以及后续治疗成本效益的研究并未充分详细地处理不确定性或一致性（内部和/或外部）问题。需要对更合适的AD进展建模方法开展进一步研究。与此同时，未来治疗的经济评估需要更明确地说明用于模拟AD的方法以及用于填充模型的数据。
