Aye Sandar, Jönsson Linus, Gustavsson Anders, Tate Ashley, Ptacek Sara Garcia, Eriksdotter Maria
Division of Neurogeriatrics Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden.
Quantity Research Stockholm Sweden.
Alzheimers Dement (Amst). 2023 Mar 29;15(1):e12422. doi: 10.1002/dad2.12422. eCollection 2023 Jan-Mar.
We examined (1) the magnitude of mortality attributed to Alzheimer's disease (AD), and (2) the effect of mortality in cost-effectiveness modeling of hypothetical disease-modifying treatment (DMT) in AD.
Data were derived from Swedish Dementia Registry ( = 39,308). Mortality was analyzed with survival analysis and multinomial logistic regression. A Markov microsimulation model was used to model the cost effectiveness of DMT using routine care as a comparator. Three scenarios were simulated: (1) indirect effect, (2) no effect on overall mortality, (3) indirect effect on AD-related mortality.
Overall mortality increased with cognitive decline, age, male sex, number of medications used, and lower body mass index. Nearly all cause-specific mortality was associated with cognitive decline. DMT increased survival by 0.35 years in scenario 1 and 0.14 years in scenario 3. DMT with no mortality effect is the least cost effective.
The results provide key mortality estimates and demonstrate influences on the cost effectiveness of DMT.
We describe cause-specific mortality in relation to disease severity in Alzheimer's disease (AD).We model different assumptions of disease-modifying treatment (DMT) on AD survival.DMT was the least cost effective when assuming no effect on AD survival.Cost effectiveness is mainly influenced by the relative cost of staying in each disease state.
我们研究了（1）归因于阿尔茨海默病（AD）的死亡率，以及（2）死亡率在AD假设性疾病修饰治疗（DMT）成本效益模型中的影响。
数据来源于瑞典痴呆症登记处（n = 39308）。采用生存分析和多项逻辑回归分析死亡率。使用马尔可夫微观模拟模型，以常规护理作为对照，对DMT的成本效益进行建模。模拟了三种情景：（1）间接效应，（2）对总死亡率无影响，（3）对AD相关死亡率的间接效应。
总死亡率随认知功能下降、年龄、男性、用药数量和较低的体重指数而增加。几乎所有特定病因死亡率都与认知功能下降有关。在情景1中，DMT使生存期延长0.35年，在情景3中延长0.14年。对死亡率无影响的DMT成本效益最低。
结果提供了关键的死亡率估计，并证明了对DMT成本效益的影响。
我们描述了与阿尔茨海默病（AD）疾病严重程度相关的特定病因死亡率。我们对AD生存期的疾病修饰治疗（DMT）的不同假设进行建模。假设对AD生存期无影响时，DMT成本效益最低。成本效益主要受停留在每种疾病状态的相对成本影响。
