Cost-Utility of Using Alzheimer's Disease Biomarkers in Cerebrospinal Fluid to Predict Progression from Mild Cognitive Impairment to Dementia
Diagnostic research criteria for Alzheimer's disease support the use of biomarkers in the cerebrospinal fluid (CSF) to improve the accuracy of the prognosis regarding progression to dementia for people with mild cognitive impairment (MCI). The aim of this study was to estimate the potential inc...
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| Veröffentlicht in: | Journal of Alzheimer's disease 2017-01, Vol.60 (4), p.1477-1487 |
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| container_title | Journal of Alzheimer's disease |
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| creator | Handels, Ron L H Wimo, Anders Dodel, Richard Kramberger, Milica G Visser, Pieter Jelle Molinuevo, José Luis Verhey, Frans R J Winblad, Bengt |
| description | Diagnostic research criteria for Alzheimer's disease support the use of biomarkers in the cerebrospinal fluid (CSF) to improve the accuracy of the prognosis regarding progression to dementia for people with mild cognitive impairment (MCI).
The aim of this study was to estimate the potential incremental cost-effectiveness ratio of adding CSF biomarker testing to the standard diagnostic workup to determine the prognosis for patients with MCI.
In an early technology assessment, a mathematical simulation model was built, using available evidence on added prognostic value as well as expert opinion to estimate the incremental costs and quality-adjusted life years (QALYs) of 20,000 virtual MCI patients with (intervention strategy) and without (control strategy) relying on CSF, from a health-care sector perspective and with a 5-year time horizon.
Adding the CSF test improved the accuracy of prognosis by 11%. This resulted in an average QALY gain of 0.046 and € 432 additional costs per patient, representing an incremental cost-effectiveness ratio of € 9,416.
The results show the potential of CSF biomarkers in current practice from a health-economics perspective. This result was, however, marked by a high degree of uncertainty, and empirical research is required into the impact of a prognosis on worrying, false-positive/negative prognosis, and stigmatization. |
| doi_str_mv | 10.3233/JAD-170324 |
| format | Article |
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The aim of this study was to estimate the potential incremental cost-effectiveness ratio of adding CSF biomarker testing to the standard diagnostic workup to determine the prognosis for patients with MCI.
In an early technology assessment, a mathematical simulation model was built, using available evidence on added prognostic value as well as expert opinion to estimate the incremental costs and quality-adjusted life years (QALYs) of 20,000 virtual MCI patients with (intervention strategy) and without (control strategy) relying on CSF, from a health-care sector perspective and with a 5-year time horizon.
Adding the CSF test improved the accuracy of prognosis by 11%. This resulted in an average QALY gain of 0.046 and € 432 additional costs per patient, representing an incremental cost-effectiveness ratio of € 9,416.
The results show the potential of CSF biomarkers in current practice from a health-economics perspective. This result was, however, marked by a high degree of uncertainty, and empirical research is required into the impact of a prognosis on worrying, false-positive/negative prognosis, and stigmatization.</description><identifier>ISSN: 1387-2877</identifier><identifier>EISSN: 1875-8908</identifier><identifier>DOI: 10.3233/JAD-170324</identifier><identifier>PMID: 29081416</identifier><language>eng</language><publisher>Netherlands: IOS Press BV</publisher><subject>Accuracy ; Adult ; Aged ; Aged, 80 and over ; Alzheimer Disease - cerebrospinal fluid ; Alzheimer Disease - economics ; Alzheimer Disease - psychology ; Alzheimer's disease ; Biomarkers ; Biomarkers - cerebrospinal fluid ; Cerebrospinal fluid ; Cognitive ability ; Cognitive Dysfunction - cerebrospinal fluid ; Cognitive Dysfunction - economics ; Cognitive Dysfunction - psychology ; Computer Simulation ; Cost analysis ; Cost-Benefit Analysis ; Dementia ; Dementia disorders ; Diagnostic systems ; Disease Progression ; False Negative Reactions ; False Positive Reactions ; Female ; Humans ; Impairment ; Male ; Mathematical models ; Medical prognosis ; Middle Aged ; Models, Theoretical ; Occupational health ; Patients ; Prognosis ; Quality-Adjusted Life Years ; Social Stigma ; Technology assessment ; Uncertainty</subject><ispartof>Journal of Alzheimer's disease, 2017-01, Vol.60 (4), p.1477-1487</ispartof><rights>Copyright IOS Press BV 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c430t-68797c961de6eeeae3f041e25020ae6ec01bbbbda7d0f0780107ba0b797293ec3</citedby><cites>FETCH-LOGICAL-c430t-68797c961de6eeeae3f041e25020ae6ec01bbbbda7d0f0780107ba0b797293ec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,550,776,881</link.rule.ids><linktorsrc>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:136987704$$EView_record_in_Swedish_Publication_Index_(SWEPUB)$$FView_record_in_$$GSwedish_Publication_Index_(SWEPUB)$$Hfree_for_read</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29081416$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:136987704$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><contributor>Vandepitte, Sophie</contributor><creatorcontrib>Handels, Ron L H</creatorcontrib><creatorcontrib>Wimo, Anders</creatorcontrib><creatorcontrib>Dodel, Richard</creatorcontrib><creatorcontrib>Kramberger, Milica G</creatorcontrib><creatorcontrib>Visser, Pieter Jelle</creatorcontrib><creatorcontrib>Molinuevo, José Luis</creatorcontrib><creatorcontrib>Verhey, Frans R J</creatorcontrib><creatorcontrib>Winblad, Bengt</creatorcontrib><title>Cost-Utility of Using Alzheimer's Disease Biomarkers in Cerebrospinal Fluid to Predict Progression from Mild Cognitive Impairment to Dementia</title><title>Journal of Alzheimer's disease</title><addtitle>J Alzheimers Dis</addtitle><description>Diagnostic research criteria for Alzheimer's disease support the use of biomarkers in the cerebrospinal fluid (CSF) to improve the accuracy of the prognosis regarding progression to dementia for people with mild cognitive impairment (MCI).
The aim of this study was to estimate the potential incremental cost-effectiveness ratio of adding CSF biomarker testing to the standard diagnostic workup to determine the prognosis for patients with MCI.
In an early technology assessment, a mathematical simulation model was built, using available evidence on added prognostic value as well as expert opinion to estimate the incremental costs and quality-adjusted life years (QALYs) of 20,000 virtual MCI patients with (intervention strategy) and without (control strategy) relying on CSF, from a health-care sector perspective and with a 5-year time horizon.
Adding the CSF test improved the accuracy of prognosis by 11%. This resulted in an average QALY gain of 0.046 and € 432 additional costs per patient, representing an incremental cost-effectiveness ratio of € 9,416.
The results show the potential of CSF biomarkers in current practice from a health-economics perspective. This result was, however, marked by a high degree of uncertainty, and empirical research is required into the impact of a prognosis on worrying, false-positive/negative prognosis, and stigmatization.</description><subject>Accuracy</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alzheimer Disease - cerebrospinal fluid</subject><subject>Alzheimer Disease - economics</subject><subject>Alzheimer Disease - psychology</subject><subject>Alzheimer's disease</subject><subject>Biomarkers</subject><subject>Biomarkers - cerebrospinal fluid</subject><subject>Cerebrospinal fluid</subject><subject>Cognitive ability</subject><subject>Cognitive Dysfunction - cerebrospinal fluid</subject><subject>Cognitive Dysfunction - economics</subject><subject>Cognitive Dysfunction - psychology</subject><subject>Computer Simulation</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Dementia</subject><subject>Dementia disorders</subject><subject>Diagnostic systems</subject><subject>Disease Progression</subject><subject>False Negative Reactions</subject><subject>False Positive Reactions</subject><subject>Female</subject><subject>Humans</subject><subject>Impairment</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Models, Theoretical</subject><subject>Occupational health</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Quality-Adjusted Life Years</subject><subject>Social Stigma</subject><subject>Technology assessment</subject><subject>Uncertainty</subject><issn>1387-2877</issn><issn>1875-8908</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNpdkcFu1DAQhi1ERcvChQdAljiAkALjOInt45KltKgIDuw5cpLJMm0Sp3YCat-Bd8ar3fbAXObXzDcje37GXgn4IFMpP35dbxKhQKbZE3YmtMoTbUA_jVpqlaRaqVP2PIRrAJBg1DN2msa-yERxxv6WLszJdqae5jvuOr4NNO74ur__hTSgfxv4hgLagPwTucH6G_SB08hL9Fh7FyYabc_P-4VaPjv-w2NLzRyz23kMgdzIO-8G_o36lpduN9JMv5FfDpMlP-A476c2uFdkX7CTzvYBXx7zim3PP_8sL5Kr718uy_VV0mQS5qTQyqjGFKLFAhEtyg4ygWkOKdhYakDUMVqrWuhAaRCgagt1nEqNxEauWHLYG_7gtNTV5Cl-7a5ylqpj6SYqrDIjAfLIvzvwk3e3C4a5Gig02Pd2RLeESphcqcJkEV-xN_-h127x8UZ7ykijdR49W7H3B6qJJwweu8cnCKj2plbR1OpgaoRfH1cu9YDtI_rgovwHhByeOg</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Handels, Ron L H</creator><creator>Wimo, Anders</creator><creator>Dodel, Richard</creator><creator>Kramberger, Milica G</creator><creator>Visser, Pieter Jelle</creator><creator>Molinuevo, José Luis</creator><creator>Verhey, Frans R J</creator><creator>Winblad, Bengt</creator><general>IOS Press BV</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope></search><sort><creationdate>20170101</creationdate><title>Cost-Utility of Using Alzheimer's Disease Biomarkers in Cerebrospinal Fluid to Predict Progression from Mild Cognitive Impairment to Dementia</title><author>Handels, Ron L H ; Wimo, Anders ; Dodel, Richard ; Kramberger, Milica G ; Visser, Pieter Jelle ; Molinuevo, José Luis ; Verhey, Frans R J ; Winblad, Bengt</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c430t-68797c961de6eeeae3f041e25020ae6ec01bbbbda7d0f0780107ba0b797293ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Accuracy</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Alzheimer Disease - cerebrospinal fluid</topic><topic>Alzheimer Disease - economics</topic><topic>Alzheimer Disease - psychology</topic><topic>Alzheimer's disease</topic><topic>Biomarkers</topic><topic>Biomarkers - cerebrospinal fluid</topic><topic>Cerebrospinal fluid</topic><topic>Cognitive ability</topic><topic>Cognitive Dysfunction - cerebrospinal fluid</topic><topic>Cognitive Dysfunction - economics</topic><topic>Cognitive Dysfunction - psychology</topic><topic>Computer Simulation</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>Dementia</topic><topic>Dementia disorders</topic><topic>Diagnostic systems</topic><topic>Disease Progression</topic><topic>False Negative Reactions</topic><topic>False Positive Reactions</topic><topic>Female</topic><topic>Humans</topic><topic>Impairment</topic><topic>Male</topic><topic>Mathematical models</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Models, Theoretical</topic><topic>Occupational health</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Quality-Adjusted Life Years</topic><topic>Social Stigma</topic><topic>Technology assessment</topic><topic>Uncertainty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Handels, Ron L H</creatorcontrib><creatorcontrib>Wimo, Anders</creatorcontrib><creatorcontrib>Dodel, Richard</creatorcontrib><creatorcontrib>Kramberger, Milica G</creatorcontrib><creatorcontrib>Visser, Pieter Jelle</creatorcontrib><creatorcontrib>Molinuevo, José Luis</creatorcontrib><creatorcontrib>Verhey, Frans R J</creatorcontrib><creatorcontrib>Winblad, Bengt</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Journal of Alzheimer's disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Handels, Ron L H</au><au>Wimo, Anders</au><au>Dodel, Richard</au><au>Kramberger, Milica G</au><au>Visser, Pieter Jelle</au><au>Molinuevo, José Luis</au><au>Verhey, Frans R J</au><au>Winblad, Bengt</au><au>Vandepitte, Sophie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-Utility of Using Alzheimer's Disease Biomarkers in Cerebrospinal Fluid to Predict Progression from Mild Cognitive Impairment to Dementia</atitle><jtitle>Journal of Alzheimer's disease</jtitle><addtitle>J Alzheimers Dis</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>60</volume><issue>4</issue><spage>1477</spage><epage>1487</epage><pages>1477-1487</pages><issn>1387-2877</issn><eissn>1875-8908</eissn><abstract>Diagnostic research criteria for Alzheimer's disease support the use of biomarkers in the cerebrospinal fluid (CSF) to improve the accuracy of the prognosis regarding progression to dementia for people with mild cognitive impairment (MCI).
The aim of this study was to estimate the potential incremental cost-effectiveness ratio of adding CSF biomarker testing to the standard diagnostic workup to determine the prognosis for patients with MCI.
In an early technology assessment, a mathematical simulation model was built, using available evidence on added prognostic value as well as expert opinion to estimate the incremental costs and quality-adjusted life years (QALYs) of 20,000 virtual MCI patients with (intervention strategy) and without (control strategy) relying on CSF, from a health-care sector perspective and with a 5-year time horizon.
Adding the CSF test improved the accuracy of prognosis by 11%. This resulted in an average QALY gain of 0.046 and € 432 additional costs per patient, representing an incremental cost-effectiveness ratio of € 9,416.
The results show the potential of CSF biomarkers in current practice from a health-economics perspective. This result was, however, marked by a high degree of uncertainty, and empirical research is required into the impact of a prognosis on worrying, false-positive/negative prognosis, and stigmatization.</abstract><cop>Netherlands</cop><pub>IOS Press BV</pub><pmid>29081416</pmid><doi>10.3233/JAD-170324</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of Alzheimer's disease, 2017-01, Vol.60 (4), p.1477-1487 |
| issn | 1387-2877 1875-8908 |
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| subjects | Accuracy Adult Aged Aged, 80 and over Alzheimer Disease - cerebrospinal fluid Alzheimer Disease - economics Alzheimer Disease - psychology Alzheimer's disease Biomarkers Biomarkers - cerebrospinal fluid Cerebrospinal fluid Cognitive ability Cognitive Dysfunction - cerebrospinal fluid Cognitive Dysfunction - economics Cognitive Dysfunction - psychology Computer Simulation Cost analysis Cost-Benefit Analysis Dementia Dementia disorders Diagnostic systems Disease Progression False Negative Reactions False Positive Reactions Female Humans Impairment Male Mathematical models Medical prognosis Middle Aged Models, Theoretical Occupational health Patients Prognosis Quality-Adjusted Life Years Social Stigma Technology assessment Uncertainty |
| title | Cost-Utility of Using Alzheimer's Disease Biomarkers in Cerebrospinal Fluid to Predict Progression from Mild Cognitive Impairment to Dementia |
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