Welberry Heidi J, Ku Li-Jung Elizabeth, Shih Sophy Tf, Jorm Louisa R, Singh Maria Fiatarone, Valenzuela Michael, Anupama Ginige Jeewani, Anstey Kaarin J, Sachdev Perminder S, McNeil John J, Lautenschlager Nicola T, Heffernan Megan, Chau Tiffany, Brodaty Henry
Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
J Prev Alzheimers Dis. 2025 Jun;12(6):100151. doi: 10.1016/j.tjpad.2025.100151. Epub 2025 Apr 3.
The Maintain Your Brain (MYB) randomised controlled trial (RCT) examined the effect of a multi-domain internet-based dementia prevention program against a control group (information only).
A cost-effective analysis (CEA) quantified the differences in costs (direct healthcare and program costs) and effectiveness outcomes between the intervention and control groups from a healthcare sector perspective.
An economic evaluation was conducted alongside the MYB RCT over three years.
Australians aged 55-77 years with at least 2 identified remediable risk factors for cognitive decline/dementia recruited from communities in New South Wales.
There were 3,025 participants in the intervention group and 3,033 in the control group with available linked healthcare data via the Sax Institute's 45 and Up Study out of the 6104 enrolled in the trial (99.2% of total cohort).
The MYB trial comprised a personalised schedule of online coaching in physical activity, nutrition, cognitive activity, and depression or anxiety management.
The two effectiveness outcomes were global cognition composite (GCC) scores and the Australian National University-Alzheimer's Disease Risk Index -short form (ANU-ADRI-SF) questionnaire scores. Costs included MYB program costs and the direct healthcare costs incurred by the MYB participants. All costs were reported in Australian dollars (AUD$) during the trial period. The time horizon of this analysis was 3 years after randomisation (2018-2021). Incremental cost-effectiveness ratio (ICERs) between the intervention and the control groups were calculated by comparing the average difference in costs to a mean difference in z score for GCC and ANU-ADRI-SF score using the bootstrapped means and 95% Confidence Intervals.
The total unadjusted program and healthcare costs over three years were similar between groups (AUD$16,521 per person in the control group and AUD$16,473 in the intervention group). After adjusting for baseline characteristics, the average difference between groups in total cost per person at three years was not statistically different: AUD$467 favouring the control group (95%CI: -$552 - $1585). This was compared to a significant mean difference (improvement) in GCC z score at three years of 0.18 (95%CI: 0.13, 0.23) and -0.57 (95%CI: -0.95, -0.24) point difference in ANU-ADRI-SF for the intervention versus control. The base case ICERs were AUD$2,568 per 1 standard deviation in z score and $823 per reduction of 1 ANU-ADRI-SF point. With 1000 bootstrapped replications, the scatterplots of ICER ellipses suggest that the MYB intervention was more effective than the control group and with no significant difference in overall healthcare costs.
The MYB trial showed cost-effectiveness for preventing cognitive decline and reducing dementia risk. Longer-term follow-up and dissemination to other cohorts is needed to confirm the impact on preventing future cases of dementia and relevance to other socio-economic and cultural/ethnic groups than those enrolled in the original trial.
“维护你的大脑”（MYB）随机对照试验（RCT）研究了基于互联网的多领域痴呆症预防计划相对于对照组（仅提供信息）的效果。
一项成本效益分析（CEA）从医疗保健部门的角度量化了干预组和对照组在成本（直接医疗保健和项目成本）和有效性结果方面的差异。
在三年时间里，与MYB随机对照试验同时进行了一项经济评估。
从新南威尔士州社区招募年龄在55 - 77岁、至少有2个已确定的可纠正认知衰退/痴呆风险因素的澳大利亚人。
干预组有3025名参与者，对照组有3033名参与者，在试验招募的6104人中，有99.2%（整个队列）通过萨克斯研究所的“45岁及以上研究”获得了可用的关联医疗保健数据。
MYB试验包括一份关于身体活动、营养、认知活动以及抑郁或焦虑管理的在线辅导个性化时间表。
两个有效性结果是总体认知综合（GCC）分数和澳大利亚国立大学 - 阿尔茨海默病风险指数简表（ANU - ADRI - SF）问卷分数。成本包括MYB项目成本以及MYB参与者产生的直接医疗保健成本。在试验期间，所有成本均以澳元（AUD$）报告。该分析的时间范围是随机分组后的3年（2018 - 2021年）。通过使用自抽样均值和95%置信区间比较成本的平均差异与GCC和ANU - ADRI - SF分数的z分数平均差异，计算干预组和对照组之间的增量成本效益比（ICER）。
三年来，两组未经调整的项目和医疗保健总成本相似（对照组每人16521澳元，干预组每人16473澳元）。在对基线特征进行调整后，三年时两组每人总成本的平均差异无统计学意义：有利于对照组467澳元（95%CI： - 552美元 - 1585美元）。相比之下，三年时GCC z分数有显著平均差异（改善）为0.18（95%CI：0.13，0.23），干预组与对照组相比，ANU - ADRI - SF差异为 - 0.57（95%CI： - 0.95， - 0.24）分。基本情况ICER为每z分数1标准差2568澳元，每降低1个ANU - ADRI - SF分数823澳元。经过1000次自抽样重复，ICER椭圆散点图表明MYB干预比对照组更有效，且总体医疗保健成本无显著差异。
MYB试验显示出在预防认知衰退和降低痴呆风险方面具有成本效益。需要进行长期随访并推广到其他队列人群，以确认对预防未来痴呆病例的影响以及与参与原始试验人群不同的其他社会经济和文化/种族群体的相关性。
