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欧洲痴呆症的成本:证据综述及方法学考量

The cost of dementia in Europe: a review of the evidence, and methodological considerations.

作者信息

Jönsson Linus, Wimo Anders

机构信息

i3 Innovus, Stockholm, Sweden.

出版信息

Pharmacoeconomics. 2009;27(5):391-403. doi: 10.2165/00019053-200927050-00004.

Abstract

Alzheimer's disease (AD) is a leading cause of disability in the elderly, leading to a high burden on caregivers and costs to society. This article describes the current level of data availability regarding the costs of AD in Europe, summarizes and compares findings from previous studies in different countries, and discusses the applicability of available data for modelling purposes. A literature review was conducted for papers in any language reporting data on costs of care for patients with diagnosed dementia or possible/probable AD. Only papers reporting patient-level data on costs were included. A total of 16 studies were identified: from the Nordic region (4), the UK (3), Spain (3), France (2), Italy (2), Belgium (1) and Germany (1). There is large variation in total cost estimates, depending on, for example, differences in study methodology, setting, type and severity of patients included, range of costs assessed and the choice of principle for valuing informal care. The median value for total annual care costs in all studies was Euro28 000 (range Euro6614-Euro64 426) [year 2005 values]. Few studies assessed aspects of disease severity other than cognitive function. The costs of AD in Europe are substantial and increase with disease severity. Methodological differences between studies make comparison across countries and healthcare systems difficult, and there is a need to standardize methods for assessing and valuing informal care. Patient-level information on resource use is required to analyse determinants of care costs and predict the impact of therapeutic interventions. More data are needed to support future economic evaluations of therapies for AD.

摘要

阿尔茨海默病(AD)是老年人残疾的主要原因,给照护者带来了沉重负担,也给社会造成了巨大成本。本文描述了欧洲有关AD成本的数据可得性现状,总结并比较了不同国家以往研究的结果,并讨论了现有数据在建模方面的适用性。我们对以任何语言发表的、报告已确诊痴呆或可能/疑似AD患者护理成本数据的论文进行了文献综述。仅纳入报告了患者层面成本数据的论文。共识别出16项研究:来自北欧地区(4项)、英国(3项)、西班牙(3项)、法国(2项)、意大利(2项)、比利时(1项)和德国(1项)。总成本估计值存在很大差异,例如,这取决于研究方法、研究背景、纳入患者的类型和严重程度、评估成本的范围以及评估非正式护理价值的原则选择。所有研究中年护理总成本的中位数为28000欧元(范围为6614欧元至64426欧元)[2005年的值]。很少有研究评估除认知功能以外的疾病严重程度方面。欧洲AD的成本巨大,且随疾病严重程度增加。研究之间的方法学差异使得跨国和跨医疗保健系统的比较变得困难,因此需要规范评估和评估非正式护理的方法。需要患者层面的资源使用信息来分析护理成本的决定因素并预测治疗干预的影响。需要更多数据来支持未来对AD治疗的经济评估。

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