Zala Darshan, Chan Dennis, McCrone Paul
Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Int J Geriatr Psychiatry. 2018 Feb;33(2):307-315. doi: 10.1002/gps.4745. Epub 2017 Jun 14.
This study aims to evaluate the impact of suboptimal treatment, defined in terms of lower population coverage (percentage of total patient population receiving optimal treatment) and delay to treatment on the cost-effectiveness of pharmacological therapies approved for the treatment of different severities of Alzheimer's disease (AD) in the UK.
A 5-year Markov model was used to simulate transition to full-time care, as delay and coverage were varied for AD patients with mild-to-moderate and moderate-to-severe dementia. The time-varying predictive equations, resource use, utilities, treatment effects and mortality were derived using published sources.
For the cohort with moderate-to-severe dementia, cost-effectiveness was optimised when delay was minimised and coverage maximised. For mild-to-moderate dementia, results were similar but varied widely depending on the inputted cost of acetylcholinesterase inhibitors.
The average cost-effectiveness of pharmacological treatments for AD is sensitive to delays to treatment and population coverage. The results of this study can inform future healthcare policy in order to maximise cost-effectiveness of pharmacological therapies for AD. Copyright © 2017 John Wiley & Sons, Ltd.
本研究旨在评估次优治疗（根据较低的人群覆盖率，即接受最佳治疗的患者总人口百分比，以及治疗延迟来定义）对英国批准用于治疗不同严重程度阿尔茨海默病（AD）的药物治疗成本效益的影响。
使用一个5年马尔可夫模型来模拟向全职护理的转变，因为轻度至中度和中度至重度痴呆的AD患者的延迟和覆盖率有所不同。时变预测方程、资源使用、效用、治疗效果和死亡率均来自已发表的资料。
对于中度至重度痴呆患者队列，当延迟最小化且覆盖率最大化时，成本效益得到优化。对于轻度至中度痴呆患者，结果相似，但因乙酰胆碱酯酶抑制剂的输入成本不同而有很大差异。
AD药物治疗的平均成本效益对治疗延迟和人群覆盖率敏感。本研究结果可为未来医疗政策提供参考，以实现AD药物治疗成本效益的最大化。版权所有© 2017约翰威立父子有限公司。
