Valcárcel-Nazco Cristina, Perestelo-Pérez Lilisbeth, Molinuevo José Luis, Mar Javier, Castilla Iván, Serrano-Aguilar Pedro
Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain Canary Islands Foundation for Health and Research (FUNCIS), Tenerife, Spain Centre for Biomedical Research of the Canary Islands (CIBICAN), La Laguna, Spain.
Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain Health Services Research on Chronic Patients Network (REDISSEC), Spain Centre for Biomedical Research of the Canary Islands (CIBICAN), La Laguna, Spain.
J Alzheimers Dis. 2014;42(3):777-88. doi: 10.3233/JAD-132216.
The use of cerebrospinal fluid (CSF) biomarkers could facilitate early detection of Alzheimer's disease (AD) in patients with mild cognitive impairment (MCI) and the differential diagnosis between AD and non-AD dementias.
To determine the cost-effectiveness of the use of amyloid-β peptide (Aβ42), total tau and phosphorylated tau proteins in CSF to diagnose AD in MCI and dementia patients.
An economic evaluation was performed by means of cost-effectiveness analysis comparing two AD diagnostic alternatives: the combined determination of Aβ42 proteins, total tau and phosphorylated tau in CSF as biomarkers of AD, and the standard clinical diagnosis based on the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINDS-ADRDA) criteria. A decision analytic model was developed to synthesize the identified evidence and to compare the costs and effectiveness associated with each diagnostic strategy. A probabilistic sensitivity analysis using 2nd order Monte Carlo simulations was performed. Subsequently, acceptability curves were calculated and ANCOVA models were applied to the results of the Monte Carlo simulations in order to identify the parameters that led greater variability in the model outcomes.
The use of CSF biomarkers as an early diagnostic strategy of AD in MCI patients is a dominant alternative (less costly and more effective strategy than standard clinical diagnostic criteria). In dementia patients, although there is a higher uncertainty, biomarkers in CSF seem a more cost-effective alternative than standard clinical diagnostic criteria.
Detecting AD in MCI patients by determining Aβ42, total tau and phosphorylated tau proteins biomarkers in CSF is a cost-effective diagnostic alternative. No conclusive results were obtained on dementia patients.
使用脑脊液（CSF）生物标志物有助于早期发现轻度认知障碍（MCI）患者的阿尔茨海默病（AD），以及AD与非AD痴呆之间的鉴别诊断。
确定使用脑脊液中的淀粉样β肽（Aβ42）、总tau蛋白和磷酸化tau蛋白诊断MCI和痴呆患者AD的成本效益。
通过成本效益分析进行经济评估，比较两种AD诊断方法：联合测定脑脊液中Aβ42蛋白、总tau蛋白和磷酸化tau蛋白作为AD的生物标志物，以及基于美国国立神经疾病和中风研究所及阿尔茨海默病及相关疾病协会（NINDS-ADRDA）标准的标准临床诊断。开发了一个决策分析模型，以综合已确定的证据，并比较每种诊断策略的成本和效果。使用二阶蒙特卡罗模拟进行概率敏感性分析。随后，计算可接受性曲线，并将协方差分析模型应用于蒙特卡罗模拟的结果，以确定导致模型结果变异性更大的参数。
在MCI患者中，使用脑脊液生物标志物作为AD的早期诊断策略是一种占优选择（比标准临床诊断标准成本更低且更有效）。在痴呆患者中，尽管不确定性较高，但脑脊液中的生物标志物似乎比标准临床诊断标准更具成本效益。
通过测定脑脊液中Aβ42、总tau蛋白和磷酸化tau蛋白生物标志物来检测MCI患者的AD是一种具有成本效益的诊断选择。在痴呆患者中未获得确凿结果。
