Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
The European Journal of Health Economics
Published in: The European Journal of Health Economics 9/2015

Open Access 01-12-2015 | Original Paper

Methodological challenges in assessing the impact of comorbidities on costs in Alzheimer’s disease clinical trials

Authors: Kristin Kahle-Wrobleski, Howard Fillit, Jonathan Kurlander, Catherine Reed, Mark Belger

Published in: The European Journal of Health Economics | Issue 9/2015

Login to get access

Abstract

Background

Alzheimer’s disease (AD) is associated with considerable costs and has a significant impact on health and social care systems.

Objective

This study assessed whether baseline comorbidities present in 2,594 patients with AD participating in two semagacestat randomized placebo-controlled trials (RCTs) would significantly impact overall costs.

Methods

Resource utilization was captured using the Resource Utilization in Dementia Scale-Lite. Comorbidities and concomitant medications were tabulated via patient and caregiver reports. Only baseline data were analyzed. Direct and indirect costs per month were calculated per patient. The relationship between cost and explanatory variables was explored in a regression model.

Results

The baseline monthly cost of care in this RCT population was £1,147 ± 2,483, with informal care costs accounting for 75 % of costs. Gender, age, and functional status were significant predictors of costs (p ≤ 0.0001). The cost ratio was not impacted when the number of comorbidities was added to the model (cost ratio = 0.95; 95 % CI 0.91–0.99) or when combined with the number of concomitant medications (cost ratio = 0.97; 95 % CI 0.95–1.00). Inconsistent findings related to the impact of individual comorbidities on costs were noted in sensitivity analyses.

Conclusions

The number of comorbidities, alone or when combined with concomitant medications, did not impact baseline costs of care, perhaps because RCTs often enroll less severely ill and more medically stable patients. However, higher costs were consistently associated with greater functional impairment similar to non-RCT databases. Supplemental sources (e.g., claims databases) are likely needed to better estimate the effects of disease and treatment on costs of illness captured in RCTs for AD.
Literature
1.
Qiu, C., Kivipelto, M., von Strauss, E.: Epidemiology of Alzheimer’s disease: occurrence, determinants, and strategies toward intervention. Dialogues. Clin. Neurosci. 11, 111–128 (2009)PubMedCentralPubMed
2.
Brookmeyer, R., Gray, S., Kawas, C.: Projections of Alzheimer’s disease in the United States and the public health impact of delaying disease onset. Am. J. Public Health 88, 1337–1342 (1998)PubMedCentralCrossRefPubMed
3.
Wimo, A., Jönsson, L., Bond, J., et al.: The worldwide economic impact of dementia 2010. Alzheimers Dement. 9, 1–11 (2013)CrossRefPubMed
4.
Brookmeyer, R., Johnson, E., Ziegler-Graham, K., Arrighi, H.M.: Forecasting the global burden of Alzheimer’s disease. Alzheimers Dement. 3, 186–191 (2007)CrossRefPubMed
5.
Zhu, C.W., Scarmeas, N., Torgan, R., et al.: Clinical features associated with costs in early AD: baseline data from the predictors study. Neurology 66, 1021–1028 (2006)CrossRefPubMed
6.
Fillit, H., Hill, J.W., Futterman, R.: Health care utilization and costs of Alzheimer’s disease: the role of co-morbid conditions, disease stage, and pharmacotherapy. Fam. Med. 34, 528–535 (2002)PubMed
7.
Jonsson, L., Wimo, A.: The cost of dementia in Europe: a review of the evidence, and methodological considerations. Pharmacoeconomics 27, 391–403 (2009)CrossRefPubMed
8.
Wimo, A., Reed, C.C., Dodel, R., et al.: The GERAS Study: a prospective observational study of costs and resource use in community dwellers with Alzheimer’s disease in three European countries—study design and baseline findings. J. Alzheimers Dis. 36, 385–399 (2013)PubMed
9.
Zhu, C.W., Torgan, R., Scarmeas, N., et al.: Home health and informal care utilization costs over time in Alzheimer’s disease. Home Health Care Serv. Q. 27, 1–20 (2008)PubMedCentralCrossRefPubMed
10.
Hill, J.W., Futterman, R., Duttagupta, S., et al.: Alzheimer’s disease and related dementias increase costs of comorbidities in managed Medicare. Neurology 58, 62–70 (2002)CrossRefPubMed
11.
Lyketsos, C.G., Toone, L., Tschanz, J., et al.: Population-based study of medical comorbidity in early dementia and “cognitive impairment, no dementia (CIND)”: association with functional and cognitive impairment: the Cache County Study. Am. J. Geriatr. Psychiatry. 13, 656–664 (2005)PubMed
12.
Zhu, C.W., Scarmeas, N., Torgan, R., et al.: Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease. Neurology 67, 998–1005 (2006)CrossRefPubMed
13.
Kuo, T.C., Zhao, Y., Weir, S., et al.: Implications of comorbidity on costs for patients with Alzheimer disease. Med. Care 46, 839–846 (2008)CrossRefPubMed
14.
Reynish, E., Cortes, F., Andrieu, S., et al.: The ICTUS Study: a prospective longitudinal observational study of 1,380 AD patients in Europe. Study design and baseline characteristics of the cohort. Neuroepidemiology 29, 29–38 (2007)CrossRefPubMed
15.
Duthie, A., Chew, D., Soiza, R.L.: Non-psychiatric comorbidity associated with Alzheimer’s disease. QJM 104, 913–920 (2011)CrossRefPubMed
16.
Getsios, D., Caro, J.J., Caro, G., Ishak, K.: AHEAD study group: assessment of health economics in Alzheimer’s disease (AHEAD): galantamine treatment in Canada. Neurology 57, 972–978 (2001)CrossRefPubMed
17.
Getsios, D., Migliaccio-Walle, K., Caro, J.J.: NICE cost-effectiveness appraisal of cholinesterase inhibitors: was the right question posed? Were the best tools used? Pharmacoeconomics 25, 997–1006 (2007)CrossRefPubMed
18.
Green, C., Shearer, J., Ritchie, C.W., Zajicek, J.P.: Model-based economic evaluation in Alzheimer’s disease: a review of the methods available to model Alzheimer’s disease progression. Value Health 14, 621–630 (2011)CrossRefPubMed
19.
Gustavsson, A., Cattelin, F., Jonsson, L.: Costs of care in a mild-to-moderate Alzheimer clinical trial sample: key resources and their determinants. Alzheimers Dement. 7, 466–473 (2011)CrossRefPubMed
20.
Boyd, C.M., Vollenweider, D., Puhan, M.A.: Informing evidence-based decision-making for patients with comorbidity: availability of necessary information in clinical trials for chronic diseases. PLoS One 7, e41601 (2012)PubMedCentralCrossRefPubMed
21.
Doody, R.S., Raman, R., Farlow, M., et al.: A phase 3 trial of semagacestat for treatment of Alzheimer’s disease. N. Engl. J. Med. 369, 341–350 (2013)CrossRefPubMed
22.
Rosen, W.G., Mohs, R.C., Davis, K.L.: A new rating scale for Alzheimer’s disease. Am. J. Psychiatr. 141, 1356–1364 (1984)CrossRefPubMed
23.
Mohs, R.C., Knopman, D., Petersen, R.C., et al.: Development of cognitive instruments for use in clinical trials of antidementia drugs: additions to the Alzheimer’s disease assessment scale that broaden its scope. The Alzheimer’s disease cooperative study. Alzheimer Dis. Assoc. Disord. 11((Suppl 2)), S13–S21 (1997)CrossRefPubMed
24.
Galasko, D., Bennett, D., Sano, M., et al.: An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. The Alzheimer’s disease cooperative study. Alzheimer Dis. Assoc. Disord. 11((Suppl 2)), S33–S39 (1997)CrossRefPubMed
25.
Galasko, D., Kershaw, P.R., Schneider, L., et al.: Galantamine maintains ability to perform activities of daily living in patients with Alzheimer’s disease. J. Am. Geriatr. Soc. 52, 1070–1076 (2004)CrossRefPubMed
26.
Folstein, M.F., Folstein, S.E., McHugh, P.R.: “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12, 189–198 (1975)CrossRefPubMed
27.
Berg, L., Miller, J.P., Baty, J., et al.: Mild senile dementia of the Alzheimer type. 4. Evaluation of intervention. Ann. Neurol. 31, 242–249 (1992)CrossRefPubMed
28.
Morris, J.C.: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 43, 2412–2414 (1993)CrossRefPubMed
29.
Cummings, J.L., Mega, M., Gray, K., et al.: The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 44, 2308–2314 (1994)CrossRefPubMed
30.
The EuroQol Group: EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16, 199–208 (1990)CrossRef
31.
Wimo, A., Wetterholm, A.L., Mastey, V., Winblad, B.: Evaluation of the resource utilization and caregiver time in anti-dementia drug trials—a quantitative battery. In: Wimo, A., Jonsson, B., Karlsson, G., Winblad, B. (eds.) The health economics of dementia, pp. 465–499. John Wiley & Sons, London (1998)
32.
Wimo, A., Winblad, B., Stoffler, A., et al.: Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer’s disease. Pharmacoeconomics 21, 327–340 (2003)CrossRefPubMed
33.
34.
35.
Johannesson, M., Borgquist, L., Jonsson, B., Rastam, L.: The costs of treating hypertension–an analysis of different cut-off points. Health Policy 18, 141–150 (1991)CrossRefPubMed
36.
37.
38.
39.
Gustavsson, A., Brinck, P., Bergvall, N., et al.: Predictors of costs of care in Alzheimer’s disease: a multinational sample of 1222 patients. Alzheimers Dement. 7, 318–327 (2011)CrossRefPubMed
40.
Handels, R.L., Wolfs, C.A., Aalten, P., et al.: Determinants of care costs of patients with dementia or cognitive impairment. Alzheimer Dis. Assoc. Disord. 27, 30–36 (2013)CrossRefPubMed
41.
Lindholm, C., Gustavsson, A., Jönsson, L., Wimo, A.: Costs explained by function rather than diagnosis–results from the SNAC Nordanstig elderly cohort in Sweden. Int. J. Geriatr. Psychiatr. 28, 454–462 (2013)CrossRef
42.
Vetrano, D.L., Tosato, M., Colloca, G., et al.: Polypharmacy in nursing home residents with severe cognitive impairment: results from the SHELTER Study. Alzheimers Dement. 9, 587–593 (2013)CrossRefPubMed
43.
Fillit, H., Cummings, J., Neumann, P., et al.: Novel approaches to incorporating pharmacoeconomic studies into phase III clinical trials for Alzheimer’s disease. J. Nutr. Health Aging 14, 640–647 (2010)CrossRefPubMed
44.
Hill, J., Fillit, H., Thomas, S.K., Chang, S.: Functional impairment, healthcare costs and the prevalence of institutionalisation in patients with Alzheimer’s disease and other dementias. Pharmacoeconomics 24, 265–280 (2006)CrossRefPubMed
Metadata
Title
Methodological challenges in assessing the impact of comorbidities on costs in Alzheimer’s disease clinical trials
Authors
Kristin Kahle-Wrobleski
Howard Fillit
Jonathan Kurlander
Catherine Reed
Mark Belger
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 9/2015
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-014-0648-7

Other articles of this Issue 9/2015

The European Journal of Health Economics 9/2015 Go to the issue

Original Paper

Health burden and costs of obesity and overweight in Germany: an update

Original Paper

An examination of the relationships between service use and alternative measures of obesity among community-dwelling adults in Ireland

Original Paper

Comparison of the preference-based EQ-5D-5L and SF-6D in patients with end-stage renal disease (ESRD)

Original Paper

Values for health states with different life durations

Original Paper

Some economics on personalized and predictive medicine

Original Paper

Endogenous risk-taking and physical appearance of sex workers