Soeren Mattke, M.D., D.Sc. Director, The USC Brain Health Observatory, Research Professor of Economics, USC Dornsife, 635 Downey Way, #505N, Los Angeles, CA 90089, Mobile: +1 202 468 5797,
J Prev Alzheimers Dis. 2024;11(5):1384-1389. doi: 10.14283/jpad.2024.81.
Multiple disease modifying treatment for Alzheimer's disease are currently in clinical development or have been recently approved for use. They have vastly different treatment properties but so far, little work has been done to quantify the impact of treatment properties on the treatment's value in terms of medical and social care costs and caregiver burden.
This study aims to analyze how the mode of treatment administration, treatment frequency and duration, and monitoring requirements affect the value of disease modifying treatments. In order to isolate these effects, we compare five hypothetical disease modifying treatments with equal efficacy and safety: (1) chronic bi-weekly intravenous infusion, (2) chronic four-weekly intravenous infusion, (3) 52 weeks fixed duration four-weekly intravenous infusion, (4) chronic subcutaneous injections, and (5) chronic oral prescription on their direct medical costs, caregiver burden, and preservation of treatment value.
Survey of Alzheimer's disease treatment clinics and retrospective data analysis.
United States.
Direct medical cost and caregiver burden of treatment administration and monitoring compared to gross treatment benefit.
Chronic bi-weekly infusion treatment had the highest direct medical cost ($45,208) and caregiver burden ($6,095), reducing the treatment value by 44%, while oral treatment with the lowest direct medical cost ($1,983) and caregiver burden ($457) reduced the treatment value by only 2%. Substantial caregiver burden was reported from the survey, with a reported average of 2.3 hours for an office visit and infusion, 44 minutes of round-trip travel time, and 78% of patients being accompanied by a caregiver for treatment.
Burden of chronic intravenous treatments exceed the gross medical and social care cost savings and value of caregiver benefit. The results suggest the need for less complex treatments that require fewer clinic visits to preserve the economic value of disease modifying treatments.
目前有多种用于治疗阿尔茨海默病的疾病修正疗法正在临床开发中或最近已获准使用。它们的治疗特性有很大的不同，但到目前为止，很少有人致力于量化治疗特性对治疗在医疗和社会保健成本及照顾者负担方面的价值的影响。
本研究旨在分析治疗管理模式、治疗频率和持续时间以及监测要求如何影响疾病修正治疗的价值。为了分离这些影响，我们比较了五种假设的具有同等疗效和安全性的疾病修正治疗方法：（1）慢性每两周静脉输注，（2）慢性每四周静脉输注，（3）52 周固定持续时间每四周静脉输注，（4）慢性皮下注射，和（5）慢性口服处方，以评估其直接医疗成本、照顾者负担和治疗价值的保留情况。
对阿尔茨海默病治疗诊所进行调查和回顾性数据分析。
美国。
与总治疗效益相比，治疗管理和监测的直接医疗成本和照顾者负担。
慢性每两周输注治疗的直接医疗成本（$45,208）和照顾者负担（$6,095）最高，降低了治疗价值的 44%，而直接医疗成本（$1,983）和照顾者负担（$457）最低的口服治疗仅降低了治疗价值的 2%。调查报告了大量的照顾者负担，每次就诊和输注的报告平均时间为 2.3 小时，往返旅行时间为 44 分钟，78%的患者接受照顾者陪同治疗。
慢性静脉治疗的负担超过了总医疗和社会保健成本节省以及照顾者效益的价值。结果表明，需要更简单的治疗方法，以减少就诊次数，从而保留疾病修正治疗的经济价值。
