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Open Access 01-04-2019 | Alzheimer's Disease | Original Research Article

Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer’s Disease Interventions

Authors: Pei-Jung Lin, Brittany D’Cruz, Ashley A. Leech, Peter J. Neumann, Myrlene Sanon Aigbogun, Dorothee Oberdhan, Tara A. Lavelle

Published in: PharmacoEconomics | Issue 4/2019

Abstract

Background and objective

Alzheimer’s disease or dementia can impose a significant burden on family and other informal caregivers. This study investigated how the inclusion of family/informal caregiver spillover effects in a cost-utility analysis may influence the reported value of Alzheimer’s disease/dementia interventions.

Methods

We used PubMed to identify Alzheimer’s disease or dementia cost-utility analyses published from 1 January, 2000 to 31 March, 2018. We reviewed and abstracted information from each study using a two-reader consensus process. We investigated the frequency and methods in which family/caregiver spillover costs and health effects were incorporated into cost-utility analyses, and examined how their inclusion may influence the reported incremental cost-effectiveness ratios.

Results

Of 63 Alzheimer’s disease/dementia cost-utility analyses meeting inclusion criteria, 44 (70%) considered at least some family/caregiver spillover costs or health effects. Thirty-two studies incorporated spillover costs only, two incorporated spillover health effects only, and ten incorporated both. The most common approach for accounting for spillover was adding informal caregiving time costs to patient costs (n = 36) and adding informal caregiver quality-adjusted life-years to patient values (n = 7). In a subset of 33 incremental cost-effectiveness ratio pairs from 19 studies, incorporating spillover outcomes made incremental cost-effectiveness ratios more favorable (n = 15; 45%) or kept the intervention cost saving (n = 13; 39%) in most cases. In fewer cases, including spillover increased incremental cost-effectiveness ratios (n = 2; 6%), kept the intervention dominated [more costs/less quality-adjusted life-years] (n = 2; 6%), or changed incremental cost-effectiveness ratio from dominated to less cost/less quality-adjusted life-years (n = 1; 3%). In 11 cases (33%), adding spillover effects into analyses resulted in a lower incremental cost-effectiveness ratio that crossed a common cost-effectiveness threshold, which could have downstream implications for programs or policies that are adopted based on cost-effectiveness analysis results.

Discussion

Most Alzheimer’s disease/dementia cost-utility analyses incorporated spillover costs, often as caregiver time costs, but considered spillover health impacts less often. In about 85% of the analyses, including Alzheimer’s disease/dementia spillover cost or health effects decreased incremental cost-effectiveness ratios or kept the intervention cost saving. The broader value of an Alzheimer’s disease/dementia intervention to society may in some cases be underestimated without considering these spillover effects on family and informal caregivers.

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Langa KM, Chernew ME, Kabeto MU, Herzog AR, Ofstedal MB, Willis RJ, et al. National estimates of the quantity and cost of informal caregiving for the elderly with dementia. J Gen Intern Med. 2001;16(11):770–8.PubMedCrossRef

Moore MJ, Zhu CW, Clipp EC. Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study. J Gerontol B Psychol Sci Soc Sci. 2001;56(4):S219–28.PubMedCrossRef

Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004;12(3):240–9.PubMedCrossRef

Association Alzheimer’s. 2017 Alzheimer’s disease facts and figures. Alzheimers Dement. 2017;13(4):325–73.CrossRef

NAC and AARP. Caregiving in the U.S. June 2015. The National Alliance for Caregiving, Bethesda, MD and the AARP Public Policy Institute, Washington DC.

National Alliance for Caregiving in Partnership with the Alzheimer’s Association. Dementia caregiving in the U.S. Bethesda, MD. 2017. http://www.caregiving.org/wp-content/uploads/2014/01/Dementia-Caregiving-in-the-US_February-2017.pdf. Accessed 3 Mar 2019.

Covinsky KE, Newcomer R, Fox P, Wood J, Sands L, Dane K, et al. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med. 2003;18(12):1006–14.PubMedCrossRef

Crespo M, Lopez J, Zarit SH. Depression and anxiety in primary caregivers: a comparative study of caregivers of demented and nondemented older persons. Int J Geriatr Psychiatry. 2005;20(6):591–2. https://doi.org/10.1002/gps.1321.PubMedCrossRef

Kim Y, Schulz R. Family caregivers’ strains: comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving. J Aging Health. 2008;20(5):483–503. https://doi.org/10.1177/0898264308317533.PubMedCrossRef

10.

Mohamed S, Rosenheck R, Lyketsos CG, Schneider LS. Caregiver burden in Alzheimer disease: cross-sectional and longitudinal patient correlates. Am J Geriatr Psychiatry. 2010;18(10):917–27. https://doi.org/10.1097/JGP.0b013e3181d5745d.PubMedCrossRefPubMedCentral

11.

Tremont G. Family caregiving in dementia. Med Health R I. 2011;94(2):36–8.PubMedPubMedCentral

12.

Ferrara M, Langiano E, Di Brango T, De Vito E, Di Cioccio L, Bauco C. Prevalence of stress, anxiety and depression in with Alzheimer caregivers. Health Qual Life Outcomes. 2008;6:93. https://doi.org/10.1186/1477-7525-6-93.PubMedCrossRefPubMedCentral

13.

Basu A, Meltzer D. Implications of spillover effects within the family for medical cost-effectiveness analysis. J Health Econ. 2005;24(4):751–73. https://doi.org/10.1016/j.jhealeco.2004.12.002.PubMedCrossRef

14.

Hoefman RJ, van Exel J, Brouwer W. How to include informal care in economic evaluations. Pharmacoeconomics. 2013;31(12):1105–19. https://doi.org/10.1007/s40273-013-0104-z.PubMedCrossRef

15.

Koopmanschap MA, van Exel JN, van den Berg B, Brouwer WB. An overview of methods and applications to value informal care in economic evaluations of healthcare. Pharmacoeconomics. 2008;26(4):269–80.PubMedCrossRef

16.

Wittenberg E, Prosser LA. Health as a family affair. N Engl J Med. 2016;374(19):1804–6. https://doi.org/10.1056/NEJMp1604456.PubMedCrossRef

17.

Gold MRSJ, Russell LB, Weinstein MC, editors. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.

18.

Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093–103. https://doi.org/10.1001/jama.2016.12195.PubMedCrossRef

19.

Krol M, Papenburg J, van Exel J. Does including informal care in economic evaluations matter? A systematic review of inclusion and impact of informal care in cost-effectiveness studies. Pharmacoeconomics. 2015;33(2):123–35. https://doi.org/10.1007/s40273-014-0218-y.PubMedCrossRef

20.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9 (W64).PubMedCrossRef

21.

Banerjee S, Wittenberg R. Clinical and cost effectiveness of services for early diagnosis and intervention in dementia. Int J Geriatr Psychiatry. 2009;24(7):748–54. https://doi.org/10.1002/gps.2191.PubMedCrossRef

22.

Bermingham SL. The appropriate use of neuroimaging in the diagnostic work-up of dementia: an economic literature review and cost-effectiveness analysis. Ont Health Technol Assess Ser. 2014;14(2):1–67.PubMedPubMedCentral

23.

Caro JJ, Salas M, Ward A, Getsios D, Mehnert A; AHEAD Study Group. Assessment of health economics in Alzheimer’s disease. Economic analysis of galantamine, a cholinesterase inhibitor, in the treatment of patients with mild to moderate Alzheimer’s disease in the Netherlands. Dement Geriatr Cogn Disord. 2002;14(2):84–9.

24.

D’Amico F, Rehill A, Knapp M, Aguirre E, Donovan H, Hoare Z, et al. Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial. J Am Med Dir Assoc. 2015;16(1):63–70. https://doi.org/10.1016/j.jamda.2014.10.020.PubMedCrossRef

25.

D’Amico F, Rehill A, Knapp M, Lowery D, Cerga-Pashoja A, Griffin M, et al. Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial. Int J Geriatr Pychiatry. 2016;31(6):656–65. https://doi.org/10.1002/gps.4376.CrossRef

26.

Davis JC, Bryan S, Marra CA, Hsiung GY, Liu-Ambrose T. Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia. Br J Sports Med. 2015;49(20):1343–7. https://doi.org/10.1136/bjsports-2013-092743.PubMedCrossRef

27.

Djalalov S, Yong J, Beca J, Black S, Saposnik G, Musa Z, et al. Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: an exploratory economic evaluation of personalized medicine. Mol Diagn Ther. 2012;16(6):389–99. https://doi.org/10.1007/s40291-012-0010-7.PubMedCrossRef

28.

Fuh JL, Wang SJ. Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer’s disease in Taiwan. Int J Geriatr Psychiatry. 2008;23(1):73–8. https://doi.org/10.1002/gps.1842.PubMedCrossRef

29.

Gagnon M, Rive B, Hux M, Guilhaume C. Cost-effectiveness of memantine compared with standard care in moderate-to-severe Alzheimer disease in Canada. Can J Psychiatry. 2007;52(8):519–26. https://doi.org/10.1177/070674370705200810.PubMedCrossRef

30.

Getsios D, Blume S, Ishak KJ, Maclaine GD. Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer’s disease: a UK evaluation using discrete-event simulation. Pharmacoeconomics. 2010;28(5):411–27. https://doi.org/10.2165/11531870-000000000-00000.PubMedCrossRef

31.

Goldfeld KS, Hamel MB, Mitchell SL. The cost-effectiveness of the decision to hospitalize nursing home residents with advanced dementia. J Pain Symptom Manag. 2013;46(5):640–51. https://doi.org/10.1016/j.jpainsymman.2012.11.007.CrossRef

32.

Green C, Picot J, Loveman E, Takeda A, Kirby J, Clegg A. Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer’s disease. Pharmacoeconomics. 2005;23(12):1271–82.PubMedCrossRef

33.

Guo S, Getsios D, Hernandez L, Cho K, Lawler E, Altincatal A, et al. Florbetaben PET in the early diagnosis of Alzheimer’s disease: a discrete event simulation to explore its potential value and key data gaps. Int J Alzheimers Dis. 2012;2012:548157. https://doi.org/10.1155/2012/548157.PubMedCrossRefPubMedCentral

34.

Gustavsson A, Van Der Putt R, Jonsson L, McShane R. Economic evaluation of cholinesterase inhibitor therapy for dementia: comparison of Alzheimer’s disease and dementia with Lewy bodies. Int J Geriatr Psychiatry. 2009;24(10):1072–8. https://doi.org/10.1002/gps.2223.PubMedCrossRef

35.

Handels RL, Joore MA, Tran-Duy A, Wimo A, Wolfs CA, Verhey FR, et al. Early cost-utility analysis of general and cerebrospinal fluid-specific Alzheimer’s disease biomarkers for hypothetical disease-modifying treatment decision in mild cognitive impairment. Alzheimers Dement. 2015;11(8):896–905. https://doi.org/10.1016/j.jalz.2015.02.009.PubMedCrossRef

36.

Hartz S, Getsios D, Tao S, Blume S, Maclaine G. Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer’s disease in Germany using discrete event simulation. BMC Neurol. 2012;12:2. https://doi.org/10.1186/1471-2377-12-2.PubMedCrossRefPubMedCentral

37.

Hoogveldt B, Rive B, Severens J, Maman K, Guilhaume C. Cost-effectiveness analysis of memantine for moderate-to-severe Alzheimer’s disease in the Netherlands. Neuropsychiatr Dis Treat. 2011;7:313–7. https://doi.org/10.2147/NDT.S19239.PubMedCrossRefPubMedCentral

38.

Hornberger J, Bae J, Watson I, Johnston J, Happich M. Clinical and cost implications of amyloid beta detection with amyloid beta positron emission tomography imaging in early Alzheimer’s disease: the case of florbetapir. Curr Med Res Opin. 2017;33(4):675–85. https://doi.org/10.1080/03007995.2016.1277197.PubMedCrossRef

39.

Hornberger J, Michalopoulos S, Dai M, Andrade P, Dilla T, Happich M. Cost-effectiveness of florbetapir-PET in Alzheimer’s disease: a Spanish societal perspective. J Ment Health Policy Econ. 2015;18(2):63–73.PubMed

40.

Hyde C, Peters J, Bond M, Rogers G, Hoyle M, Anderson R, et al. Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer’s disease: systematic review and economic model. Age Ageing. 2013;42(1):14–20. https://doi.org/10.1093/ageing/afs165.PubMedCrossRef

41.

Ikeda S, Yamada Y, Ikegami N. Economic evaluation of donepezil treatment for Alzheimer’s disease in Japan. Dement Geriatr Cogn Disord. 2002;13(1):33–9.PubMedCrossRef

42.

Jones RW, McCrone P, Guilhaume C. Cost effectiveness of memantine in Alzheimer’s disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging. 2004;21(9):607–20.PubMedCrossRef

43.

Jonsson L. Cost-effectiveness of memantine for moderate to severe Alzheimer’s disease in Sweden. Am J Geriatr Pharmacother. 2005;3(2):77–86. https://doi.org/10.1016/j.amjopharm.2005.05.002.PubMedCrossRef

44.

Kasuya M, Meguro K. Health economic effect of donepezil treatment for CDR 0.5 converters to Alzheimer’s disease as shown by the Markov model. Arch Gerontol Geriatr. 2010;50(3):295–9. https://doi.org/10.1016/j.archger.2009.04.014.

45.

Kirbach S, Simpson K, Nietert PJ, Mintzer J. A Markov model of the cost effectiveness of olanzapine treatment for agitation and psychosis in Alzheimer’s disease. Clin Drug Investig. 2008;28(5):291–303.PubMedCrossRef

46.

Lachaine J, Beauchemin C, Legault M, Bineau S. Economic evaluation of the impact of memantine on time to nursing home admission in the treatment of Alzheimer disease. Can J Psychiatry. 2011;56(10):596–604. https://doi.org/10.1177/070674371105601005.PubMedCrossRef

47.

Lopez-Bastida J, Hart W, Garcia-Perez L, Linertova R. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease. J Alzheimers Dis. 2009;16(2):399–407. https://doi.org/10.3233/JAD-2009-0965.PubMedCrossRef

48.

MacNeil Vroomen J, Bosmans JE, Eekhout I, Joling KJ, van Mierlo LD, Meiland FJ, et al. The cost-effectiveness of two forms of case management compared to a control group for persons with dementia and their informal caregivers from a societal perspective. PLoS One. 2016;11(9):e0160908. https://doi.org/10.1371/journal.pone.0160908.PubMedCrossRefPubMedCentral

49.

Martikainen J, Valtonen H, Pirttila T. Potential cost-effectiveness of a family-based program in mild Alzheimer’s disease patients. Eur J Health Econ. 2004;5(2):136–42. https://doi.org/10.1007/s10198-003-0214-1.PubMedCrossRef

50.

McMahon PM, Araki SS, Neumann PJ, Harris GJ, Gazelle GS. Cost-effectiveness of functional imaging tests in the diagnosis of Alzheimer disease. Radiology. 2000;217(1):58–68. https://doi.org/10.1148/radiology.217.1.r00se1358.PubMedCrossRef

51.

McMahon PM, Araki SS, Sandberg EA, Neumann PJ, Gazelle GS. Cost-effectiveness of PET in the diagnosis of Alzheimer disease. Radiology. 2003;228(2):515–22. https://doi.org/10.1148/radiol.2282020915.PubMedCrossRef

52.

Meeuwsen E, Melis R, van der Aa G, Goluke-Willemse G, de Leest B, van Raak F, et al. Cost-effectiveness of one year dementia follow-up care by memory clinics or general practitioners: economic evaluation of a randomised controlled trial. PLoS One. 2013;8(11):e79797. https://doi.org/10.1371/journal.pone.0079797.PubMedCrossRefPubMedCentral

53.

Mirsaeedi-Farahani K, Halpern CH, Baltuch GH, Wolk DA, Stein SC. Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis. J Neurol. 2015;262(5):1191–7. https://doi.org/10.1007/s00415-015-7688-5.PubMedCrossRef

54.

Nagy B, Brennan A, Brandtmuller A, Thomas SK, Sullivan SD, Akehurst R. Assessing the cost-effectiveness of the rivastigmine transdermal patch for Alzheimer’s disease in the UK using MMSE- and ADL-based models. Int J Geriatr Psychiatry. 2011;26(5):483–94. https://doi.org/10.1002/gps.2551.PubMedCrossRef

55.

Payne K, Davies LM, Noyce PR, Weiss MC. The value of the managed entry of new drugs: a case study of donepezil. Int J Technol Assess Health Care. 2003;19(1):114–28.PubMedCrossRef

56.

Peters JL, Anderson R, Hoyle M, Hyde C. Evolution of a cost-utility model of donepezil for Alzheimer’s disease. Int J Technol Assess Health Care. 2013;29(2):147–54. https://doi.org/10.1017/S026646231300007X.PubMedCrossRef

57.

Pfeil AM, Kressig RW, Szucs TD. Alzheimer’s dementia: budget impact and cost-utility analysis of a combination treatment of a cholinesterase inhibitor and memantine in Switzerland. Swiss Med Wkly. 2012;142:w13676. https://doi.org/10.4414/smw.2012.13676.PubMedCrossRef

58.

Rive B, Aarsland D, Grishchenko M, Cochran J, Lamure M, Toumi M. Cost-effectiveness of memantine in moderate and severe Alzheimer’s disease in Norway. Int J Geriatr Psychiatry. 2012;27(6):573–82. https://doi.org/10.1002/gps.2755.PubMedCrossRef

59.

Rive B, Grishchenko M, Guilhaume-Goulant C, Katona C, Livingston G, Lamure M, et al. Cost effectiveness of memantine in Alzheimer’s disease in the UK. J Med Econ. 2010;13(2):371–80. https://doi.org/10.3111/13696998.2010.491347.PubMedCrossRef

60.

Romeo R, Knapp M, Hellier J, Dewey M, Ballard C, Baldwin R, et al. Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial. Br J Psychiatry. 2013;202:121–8. https://doi.org/10.1192/bjp.bp.112.115212.PubMedCrossRef

61.

Saint-Laurent Thibault C, Ozer Stillman I, Chen S, Getsios D, Proskorovsky I, Hernandez L, et al. Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer’s type in the US. J Med Econ. 2015;18(11):930–43. https://doi.org/10.3111/13696998.2015.1063501.PubMedCrossRef

62.

Skoldunger A, Johnell K, Winblad B, Wimo A. Mortality and treatment costs have a great impact on the cost-effectiveness of disease modifying treatment in Alzheimer’s disease: a simulation study. Curr Alzheimer Res. 2013;10(2):207–16.PubMedCrossRef

63.

Sogaard R, Sorensen J, Waldorff FB, Eckermann A, Buss DV, Phung KT, et al. Early psychosocial intervention in Alzheimer’s disease: cost utility evaluation alongside the Danish Alzheimer’s Intervention Study (DAISY). BMJ Open. 2014;4(1):e004105. https://doi.org/10.1136/bmjopen-2013-004105.PubMedCrossRefPubMedCentral

64.

Suh GH. Modeling the cost-effectiveness of galantamine for mild to moderately severe Alzheimer’s disease in Korea. Value Health. 2009;12(Suppl. 3):S49–54. https://doi.org/10.1111/j.1524-4733.2009.00627.x.PubMedCrossRef

65.

Tanajewski L, Franklin M, Gkountouras G, Berdunov V, Harwood RH, Goldberg SE, et al. Economic evaluation of a general hospital unit for older people with delirium and dementia (TEAM randomised controlled trial). PLoS One. 2015;10(12):e0140662. https://doi.org/10.1371/journal.pone.0140662.PubMedCrossRefPubMedCentral

66.

Teipel SJ, Ewers M, Reisig V, Schweikert B, Hampel H, Happich M. Long-term cost-effectiveness of donepezil for the treatment of Alzheimer’s disease. Eur Arch Psychiatry Clin Neurosci. 2007;257(6):330–6. https://doi.org/10.1007/s00406-007-0727-1.PubMedCrossRef

67.

Tong T, Thokala P, McMillan B, Ghosh R, Brazier J. Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care. Int J Geriatr Psychiatry. 2017;32(12):1392–400. https://doi.org/10.1002/gps.4626.PubMedCrossRef

68.

Touchon J, Lachaine J, Beauchemin C, Granghaud A, Rive B, Bineau S. The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer’s disease to nursing homes: cost-effectiveness analysis in France. Eur J Health Econ. 2014;15(8):791–800. https://doi.org/10.1007/s10198-013-0523-y.PubMedCrossRef

69.

Ward A, Caro JJ, Getsios D, Ishak K, O’Brien J, Bullock R, et al. Assessment of health economics in Alzheimer’s disease (AHEAD): treatment with galantamine in the UK. Int J Geriatr Psychiatry. 2003;18(8):740–7. https://doi.org/10.1002/gps.919.PubMedCrossRef

70.

Weycker D, Taneja C, Edelsberg J, Erder MH, Schmitt FA, Setyawan J, et al. Cost-effectiveness of memantine in moderate-to-severe Alzheimer’s disease patients receiving donepezil. Curr Med Res Opin. 2007;23(5):1187–97. https://doi.org/10.1185/030079907X188071.PubMedCrossRef

71.

Willan AR, Goeree R, Pullenayegum EM, McBurney C, Blackhouse G. Economic evaluation of rivastigmine in patients with Parkinson’s disease dementia. Pharmacoeconomics. 2006;24(1):93–106.PubMedCrossRef

72.

Wolfs CA, Dirksen CD, Kessels A, Severens JL, Verhey FR. Economic evaluation of an integrated diagnostic approach for psychogeriatric patients: results of a randomized controlled trial. Arch Gen Psychiatry. 2009;66(3):313–23. https://doi.org/10.1001/archgenpsychiatry.2008.544.PubMedCrossRef

73.

Woods RT, Orrell M, Bruce E, Edwards RT, Hoare Z, Hounsome B, et al. REMCARE: pragmatic multi-centre randomised trial of reminiscence groups for people with dementia and their family carers: effectiveness and economic analysis. PLoS One. 2016;11(4):e0152843. https://doi.org/10.1371/journal.pone.0152843.PubMedCrossRefPubMedCentral

74.

Yang KC, Chen HH. Probabilistic cost-effectiveness analysis of vaccination for mild or moderate Alzheimer’s disease. Curr Alzheimer Res. 2016;13(7):809–16.PubMedCrossRef

75.

Yu SY, Lee TJ, Jang SH, Han JW, Kim TH, Kim KW. Cost-effectiveness of nationwide opportunistic screening program for dementia in South Korea. J Alzheimers Dis. 2015;44(1):195–204. https://doi.org/10.3233/JAD-141632.PubMedCrossRef

76.

Zhang Y, Kivipelto M, Solomon A, Wimo A. Cost-effectiveness of a health intervention program with risk reductions for getting demented: results of a Markov model in a Swedish/Finnish setting. J Alzheimers Dis. 2011;26(4):735–44. https://doi.org/10.3233/JAD-2011-110065.PubMedCrossRef

77.

Zwijsen SA, Bosmans JE, Gerritsen DL, Pot AM, Hertogh CM, Smalbrugge M. The cost-effectiveness of grip on challenging behaviour: an economic evaluation of a care programme for managing challenging behaviour. Int J Geriatr Psychiatry. 2016;31(6):567–74. https://doi.org/10.1002/gps.4360.PubMedCrossRef

78.

Brown H, D’Amico F, Knapp M, Orrell M, Rehill A, Vale L, et al. A cost effectiveness analysis of maintenance cognitive stimulation therapy (MCST) for people with dementia: examining the influence of cognitive ability and living arrangements. Aging Ment Health. 2018:1–6. https://doi.org/10.1080/13607863.2018.1442410.

79.

Gomes M, Pennington M, Wittenberg R, Knapp M, Black N, Smith S. Cost-effectiveness of memory assessment services for the diagnosis and early support of patients with dementia in England. J Health Serv Res Policy. 2017;22(4):226–35. https://doi.org/10.1177/1355819617714816.PubMedCrossRef

80.

Handels RLH, Wimo A, Dodel R, Kramberger MG, Visser PJ, Molinuevo JL, et al. Cost-utility of using Alzheimer’s disease biomarkers in cerebrospinal fluid to predict progression from mild cognitive impairment to dementia. J Alzheimers Dis. 2017;60(4):1477–87. https://doi.org/10.3233/jad-170324.PubMedCrossRef

81.

Lee SA, Sposato LA, Hachinski V, Cipriano LE. Cost-effectiveness of cerebrospinal biomarkers for the diagnosis of Alzheimer’s disease. Alzheimers Res Ther. 2017;9(1):18. https://doi.org/10.1186/s13195-017-0243-0.PubMedCrossRefPubMedCentral

82.

Saxena N, George PP, Teo KW, Tan WS, Ng C, Heng BH, et al. Evaluation of an integrated primary care-led dementia shared care program in Singapore: an effectiveness and cost-effectiveness study. Geriatr Gerontol Int. 2018;18(3):479–86. https://doi.org/10.1111/ggi.13196.PubMedCrossRef

83.

Sopina E, Sorensen J, Beyer N, Hasselbalch SG, Waldemar G. Cost-effectiveness of a randomised trial of physical activity in Alzheimer’s disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark. BMJ Open. 2017;7(6):e015217. https://doi.org/10.1136/bmjopen-2016-015217.PubMedCrossRefPubMedCentral

84.

Wimo A, Gustavsson A, Jonsson L, Winblad B, Hsu MA, Gannon B. Application of resource utilization in dementia (RUD) instrument in a global setting. Alzheimers Dement. 2013;9(4):429-35.e17. https://doi.org/10.1016/j.jalz.2012.06.008.CrossRef

85.

Bergvall N, Brinck P, Eek D, Gustavsson A, Wimo A, Winblad B, et al. Relative importance of patient disease indicators on informal care and caregiver burden in Alzheimer’s disease. Int Psychogeriatr. 2011;23(1):73–85. https://doi.org/10.1017/s1041610210000785.PubMedCrossRef

86.

Neubauer S, Holle R, Menn P, Grossfeld-Schmitz M, Graesel E. Measurement of informal care time in a study of patients with dementia. Int Psychogeriatr. 2008;20(6):1160–76. https://doi.org/10.1017/s1041610208007564.PubMedCrossRef

87.

NAC. Alzheimer’s caregiving in the U.S. 2009. National Alliance for Caregiving, Bethesda, MD.

88.

Bobinac A, van Exel NJ, Rutten FF, Brouwer WB. Health effects in significant others: separating family and care-giving effects. Med Decis Mak. 2011;31(2):292–8. https://doi.org/10.1177/0272989x10374212.CrossRef

89.

Lavelle TA, Wittenberg E, Lamarand K, Prosser LA. Variation in the spillover effects of illness on parents, spouses, and children of the chronically ill. Appl Health Econ Health Policy. 2014;12(2):117–24. https://doi.org/10.1007/s40258-014-0079-8.PubMedCrossRefPubMedCentral

90.

Al-Janabi H, Van Exel J, Brouwer W, Trotter C, Glennie L, Hannigan L, et al. Measuring health spillovers for economic evaluation: a case study in meningitis. Health Econ. 2016;25(12):1529–44. https://doi.org/10.1002/hec.3259.PubMedCrossRef

91.

Reed C, Belger M, Dell’agnello G, Wimo A, Argimon JM, Bruno G, et al. Caregiver burden in Alzheimer’s disease: differential associations in adult-child and spousal caregivers in the GERAS observational study. Dement Geriatr Cogn Dis Extra. 2014;4(1):51–64. https://doi.org/10.1159/000358234.PubMedCrossRefPubMedCentral

92.

Goodrich K, Kaambwa B, Al-Janabi H. The inclusion of informal care in applied economic evaluation: a review. Value Health. 2012;15(6):975–81. https://doi.org/10.1016/j.jval.2012.05.009.PubMedCrossRef

93.

Brazier J, Connell J, Papaioannou D, Mukuria C, Mulhern B, Peasgood T, et al. A systematic review, psychometric analysis and qualitative assessment of generic preference-based measures of health in mental health populations and the estimation of mapping functions from widely used specific measures. Health Technol Assess. 2014;18(34):vii–viii, xiii–xxv, 1–188. https://doi.org/10.3310/hta18340.

94.

Zhu CW, Leibman C, McLaughlin T, Scarmeas N, Albert M, Brandt J, et al. The effects of patient function and dependence on costs of care in Alzheimer’s disease. J Am Geriatr Soc. 2008;56(8):1497–503. https://doi.org/10.1111/j.1532-5415.2008.01798.x.PubMedCrossRefPubMedCentral

95.

Lavelle TA, Kent DM, Lundquist CM, Thorat T, Cohen JT, Wong JB, et al. Patient variability seldom assessed in cost-effectiveness studies. Med Decis Mak. 2018;38(4):487–94. https://doi.org/10.1177/0272989x17746989.CrossRef

96.

Schulz R, Mendelsohn AB, Haley WE, Mahoney D, Allen RS, Zhang S, et al. End-of-life care and the effects of bereavement on family caregivers of persons with dementia. N Engl J Med. 2003;349(20):1936–42. https://doi.org/10.1056/NEJMsa035373.PubMedCrossRef

97.

Brouwer WB, van Exel NJ, Koopmanschap MA, Rutten FF. The valuation of informal care in economic appraisal: a consideration of individual choice and societal costs of time. Int J Technol Assess Health Care. 1999;15(1):147–60.PubMedCrossRef

98.

Neumann PJ, Thorat T, Shi J, Saret CJ, Cohen JT. The changing face of the cost-utility literature, 1990–2012. Value Health. 2015;18(2):271–7. https://doi.org/10.1016/j.jval.2014.12.002.PubMedCrossRef

Title: Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer’s Disease Interventions
Authors: Pei-Jung Lin
Brittany D’Cruz
Ashley A. Leech
Peter J. Neumann
Myrlene Sanon Aigbogun
Dorothee Oberdhan
Tara A. Lavelle
Publication date: 01-04-2019
Publisher: Springer International Publishing
Keywords: Alzheimer's Disease
Dementia
Alzheimer's Disease
Dementia
Published in: PharmacoEconomics / Issue 4/2019
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI: https://doi.org/10.1007/s40273-019-00788-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer’s Disease Interventions

Abstract

Background and objective

Methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and objective

Methods

Results

Discussion

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The Inclusion of Spillover Effects in Economic Evaluation: A Public Health Economics Perspective

Expanding the Scope of Costs and Benefits for Economic Evaluations in Health: Some Words of Caution

Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England