Centre for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
J Alzheimers Dis. 2020;75(4):1141-1152. doi: 10.3233/JAD-190760.
Alzheimer's disease (AD) is one of the most disabling conditions worldwide and the disease burden increases with the aging global population. There are only a few prospective studies using real-world data to support effective healthcare resource utilization (HCRU) in AD.
To confirm the association between HCRU and AD severity in a real-world population, including patients with all cognitive impairment (CI) severities.
Data were drawn from a multi-national, cross-sectional survey of physicians and their consulted patients with all stages (very mild, mild, moderate, and severe) of CI including AD conducted in France, Germany, Italy, Spain, UK, US, and Canada. Elements of HCRU including medical consultations, professional caregiver hours, hospitalization, and institutionalization were compared between CI severity subgroups, and by country and region.
6,143 CI patients were included with very mild (n = 659), mild (n = 2,473), moderate (n = 2,603), and severe (n = 408) dementia. HCRU increased with increasing CI severity (p < 0.001) for the majority of elements measured. Further analyses of overall and regional populations also confirmed significant increases in most HCRU elements with increasing disease severity. The general trend toward increased HCRU with increased CI severity was also seen in individual countries. Individual country data appeared to indicate that earlier intervention decreased hospitalizations and full-time institutionalization at the later (more severe) disease stages.
Our findings confirmed that HCRU increases with increasing CI severity. Effective intervention in early disease could therefore reduce or delay incurring greater HCRU costs associated with more severe disease. Further studies are needed to confirm this hypothesis.
阿尔茨海默病（AD）是全球最具致残性的疾病之一，且随着全球人口老龄化，疾病负担也在增加。仅有少数前瞻性研究使用真实世界数据来支持 AD 的有效医疗资源利用（HCRU）。
在真实人群中确认 HCRU 与 AD 严重程度之间的关联，包括所有认知障碍（CI）严重程度的患者。
数据来自于一项多国、横断面的医生及其咨询患者的调查，这些患者处于 CI 的所有阶段（非常轻度、轻度、中度和重度），包括 AD，在法国、德国、意大利、西班牙、英国、美国和加拿大进行。比较了 CI 严重程度亚组以及各国和各地区之间的 HCRU 要素，包括医疗咨询、专业护理人员时间、住院和机构化。
纳入了 6143 名 CI 患者，包括非常轻度（n = 659）、轻度（n = 2473）、中度（n = 2603）和重度（n = 408）痴呆症。对于大多数测量的要素，HCRU 随着 CI 严重程度的增加而增加（p < 0.001）。对总体和区域人群的进一步分析也证实，随着疾病严重程度的增加，大多数 HCRU 要素的增加具有统计学意义。随着 CI 严重程度的增加，HCRU 增加的总体趋势也在各个国家中显现出来。个别国家的数据似乎表明，早期干预可减少后期（更严重）疾病阶段的住院和全日制机构化。
我们的研究结果证实，HCRU 随着 CI 严重程度的增加而增加。因此，在疾病早期进行有效干预可能会降低或延迟与更严重疾病相关的更高 HCRU 成本。需要进一步的研究来证实这一假设。
