Medina Miguel, Khachaturian Zaven S, Rossor Martin, Avila Jesús, Cedazo-Minguez Angel
CIBERNED (Network Center for Biomedical Research in Neurodegenerative Diseases), ISCIII, Madrid, Spain.
CIEN Foundation, Reina Sofia Foundation Alzheimer Center, Madrid, Spain.
Alzheimers Dement (N Y). 2017 Sep 19;3(4):571-578. doi: 10.1016/j.trci.2017.08.009. eCollection 2017 Nov.
The global strategic goal of reducing health care cost, especially the prospects for massive increases due to expanding markets for health care services demanded by aging populations and/or people with a wide range of chronic disorders-disabilities, is a complex and formidable challenge with many facets. Current projections predict marked increases in the demand for health driven by both the exponential climb in the prevalence of chronic disabilities and the increases in the absolute numbers of people in need of some form of health care. Thus, the looming predicament for the economics of health care systems worldwide mandates the formulation of a strategic goal to foster significant expansion of global R&D efforts to discover and develop wide-ranging interventions to delay and/or prevent the onset of chronic disabling conditions. The rationale for adopting such a tactical objective is based on the premise that the costs and prevalence of chronic disabling conditions will be reduced by half even if a modest delay of 5 years in the onset of disability is obtained by a highly focused multinational research initiative. Because of the recent history of many failures in drug trials, the central thesis of this paper is to argue for the exploration-adoption of novel mechanistic ideas, theories, and paradigms for developing wide range and/or types of interventions. Although the primary focus of our discussion has been on biological approaches to therapy, we recognize the importance of emerging knowledge on nonpharmacological interventions and their potential impact in reducing health care costs. Although we may not find a drug to cure or prevent dementia for a long time, research is starting to demonstrate the potential contributes of nonpharmacological interventions toward the economics of health care in terms of rehabilitation, promoting autonomy, and potential to delay institutionalization, thus promoting healthy aging and reductions in the cost of care.
降低医疗成本的全球战略目标，尤其是由于老龄化人口和/或患有各种慢性疾病-残疾的人群对医疗服务市场不断扩大所带来的大幅增长前景，是一个具有多方面的复杂而艰巨的挑战。当前的预测表明，慢性残疾患病率呈指数级攀升以及需要某种形式医疗保健的绝对人数增加，将推动对医疗需求的显著增长。因此，全球医疗保健系统经济迫在眉睫的困境要求制定一项战略目标，以大力扩大全球研发工作，发现并开发广泛的干预措施，以延缓和/或预防慢性致残疾病的发生。采用这一战术目标的基本原理基于这样一个前提，即即使通过一项高度集中的跨国研究计划仅将残疾发病时间适度推迟5年，慢性致残疾病的成本和患病率也将减半。鉴于药物试验近期屡屡失败的历史，本文的核心论点是主张探索并采用新颖的机制理念、理论和范式来开发广泛的干预措施类型。尽管我们讨论的主要焦点一直是生物治疗方法，但我们认识到关于非药物干预的新知识及其在降低医疗成本方面的潜在影响的重要性。尽管我们可能在很长一段时间内都找不到治愈或预防痴呆症的药物，但研究已开始证明非药物干预在康复、促进自主性以及延缓机构化的潜力等方面对医疗保健经济的潜在贡献，从而促进健康老龄化并降低护理成本。
