Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Cost Effectiveness Analysis of Alzheimer's Disease
Alzheimer Hastalığı'nın Maliyet Etkililik Analizi
Selin EROYMAKa, Vahit YİĞİTa
aSüleyman Demirel University Economics and Administrative Sciences of Faculty, Department of Health Management, Isparta, TURKEY
Turkiye Klinikleri J Health Sci. 2020;5(1):99-111
doi: 10.5336/healthsci.2019-66536
Article Language: EN
Full Text
ABSTRACT
 Objective: Chronic diseases, comparing to the other type of diseases, consume most of the resources in the health systems. Alzheimer's Disease (AD) is a chronic cerebral disorder and is the most common type of dementia. The purpose of this research is to analyze cost effectiveness according to stages of AD from the perspective of Social Security Institution (SSI) and the society and to determine the burden of the disease on the country's budget. Material and Methods: Using the Markov Model, three parameters were calculated in the study: lifelong cost, average survival time (ST) (year), and quality adjusted life year (QALY). Results: According to the cost-effectiveness analysis, treatment in early-stage causes additional ₺ 41.237,55 cost and provides additional 1.10 QALY comparing to the treatment in severe-stage. Likewise, treatment in moderate-stage causes an additional ₺ (-) 40.439,83 cost and provides additional 1.07 QALY comparing to the treatment in severe-stage. According to the results of the budget impact analysis made from the SSI perspective for AD, 0.66% of the total health expenditures were spent on the treatment of this disease. The social cost of AD was estimated as ₺ 14.462.457,106. Conclusion: The study was concluded that early and moderate-stage treatment of AD is cost-effective compared to severestage treatment. As a result of the study, it was revealed that the social and economic costs increased and the quality of life of the patients decreased in the progress stages of AD. The results of this study are thought to be important in terms of the assessment of the economic impact of AD in the Turkey.

Keywords: Cost effectiveness analysis; Alzheimer's disease; Markov model
ÖZET
 Amaç: Diğer hastalıklar ile karşılaştırıldığında kronik hastalıklar, sağlık sistemi içinde kaynakların çoğunu tüketmektedir. Alzheimer Hastalığı (AH) kronik bir beyin rahatsızlığıdır ve en sık görülen demans tipidir. Bu araştırmanın amacı, AH'nin evrelerine göre Sosyal Güvenlik Kurumu (SGK) ve toplum perspektifinden maliyet etkililiğini analiz etmek ve hastalığın ülke bütçesi üzerindeki yükünü belirlemektir. Gereç ve Yöntemler: Araştırmada Markov modeli kullanılarak üç parametre hesaplanmıştır. Bunlar; yaşam boyu maliyet, ortalama yaşam süresi (year) ve kaliteye ayarlı yaşam yıllarıdır (QALY). Bulgular: Maliyet etkililik analizi sonucuna göre, AH'yi erken evrede tedavi etmek ileri evrede tedavi etmeye göre ilave ₺ 41.237,55 maliyet ve 1,10 QALY sağlamaktadır. AH'yi orta evrede tedavi etmek ileri evrede tedavi etmeye göre ise ilave ₺ (-) 40.439,83 maliyet ve 1,07 QALY sağlamaktadır. SGK perspektifinden yapılan bütçe etki analizinin sonuçlarına göre toplam sağlık harcamalarının %0,66'sının bu hastalığın tedavisine harcandığı tespit edilmiştir. AH'nin sosyal maliyeti ise ₺ 14.462.457.106 olarak tahmin edilmiştir. Sonuç: Çalışmada AH'nin erken ve orta evrede tedavi edilmesinin ileri evrede tedavi edilmesine göre en maliyet-etkili seçenek olduğu sonucuna varılmıştır. Araştırma sonucunda, AH'nin ilerleyen aşamalarında sosyal ve ekonomik maliyetlerin arttığı, hastaların yaşam kalitesinin düştüğü ortaya çıkmıştır. Bu çalışmanın sonuçlarının, AH'nin Türkiye'deki ekonomik ve sosyal etkisinin değerlendirilmesi açısından önemli olduğu düşünülmektedir.

Anahtar Kelimeler: Maliyet etkililik analizi; Alzheimer hastalığı; Markov modeli
REFERENCES:
  1. Organisation for Economic Co-operation and Development (OECD). Emerging trends in biomedicine and health technology innovation: addressing the global challenge of alzheimer's. Paris: Paris OECD Science, Technology and Industry Policy Papers; 2013. p.44.
  2. Prince M, Wimo A, Guerchet M, Ali GC, Wu Y, Prina AM. World Alzheimer Report 2015: The global impact of dementia an analysis of prevalence, incidence, costs and tends. London: Alzheimer Dis Int; 2015. p.81.
  3. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673-734. [Crossref] 
  4. Patterson C. World Alzheimer Report 2018: The state of the art of dementia research: New frontiers. London: Alzheimer Dis Int; 2018. p.48.
  5. Prince M, Guerchet M, Prina M. Policy brief for heads of goverment: the global impcat dementia 2013-2050. London: Alzheimer Dis Int; 2013. p.8.
  6. Koca E, Taşkapilioğlu Ö, Bakar M. Caregiver burden in different stages of Alzheimer's disease. Noro Psikiyatr Ars. 2017;54(1):82-6. [Crossref]  [PubMed]  [PMC] 
  7. Wimo A, Ballard C, Brayne C, Gauthier S, Handels R, Jones RW, et al. Health economic evaluation of treatments for Alzheimer's disease: impact of new diagnostic criteria. J Intern Med. 2014;275(3):304-16. [Crossref]  [PubMed] 
  8. Alzheimer's Association. Alzheimer's disease facts and figures includes a special report on disclosing a diagnosis of alzheimer's disease. New York: Alzheimer's Association Public Policy Office; 2015. p.83.
  9. Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer's disease. Alzheimers Dement. 2007;3(3):186-91. [Crossref]  [PubMed] 
  10. McLaughlin T, Feldman H, Fillit H, Sano M, Schmitt F, Aisen P, et al. Dependence as a unifying construct in defining Alzheimer's disease severity. Alzheimers Dement. 2010;6(6):482-93. [Crossref]  [PubMed]  [PMC] 
  11. Comas HA, Knapp M. Dementia care in Canada, China, Indonesia, Mexico, South Africa, South Korea and Switzerlan. World Alzheimer Report: Improving healthcare for people living with dementia coverage, quality and costs now and in the future. London: Alzheimer's Dis Int; 2016. p.84-104.
  12. Wimo A, Winblad B, Jönsson L. The worldwide societal costs of dementia: estimates for 2009. Alzheimers Dement. 2010;6(2):98-103. [Crossref]  [PubMed] 
  13. Prince M, Bryce R, Ferri C. World Alzheimer Report 2011: The benefits of early diagnosis and intervention. London: Alzheimer's Dis Int; 2011. p.65.
  14. Jia J, Wei C, Chen S, Li F, Tang Y, Qin W, et al. The cost of Alzheimer's disease in China and re-estimation of costs worldwide. Alzheimers Dement. 2018;14(4):483-91. [Crossref]  [PubMed] 
  15. Maréchal L, Le Ber I, Hannequin D, Campion D, Brice A. Alzheimer's disease and other dementias. In: Gorwood P, Hamon M, eds. Psychopharmacogenetics. 1st ed. New York: Springer; 2006. p.149-76. [Crossref] 
  16. Trabucchi M. An economic perspective on Alzheimer's disease. J Geriatr Psychiatry Neurol. 1999;12(1):29-38. [Crossref]  [PubMed] 
  17. Allegri RF, Butman J, Arizaga RL, Machnicki G, Serrano C, Taragano FE, et al. Economic impact of dementia in developing countries: an evaluation of sosts of Alzheimer-type dementia in Argentina. Int Psychogeriatr. 2007;19(04):705-18. [Crossref]  [PubMed] 
  18. Castro DM, Dillon C, Machnicki G, Allegrim RF. The economic cost of Alzheimer's disease: family or public-health burden? Dement Neuropsycholog. 2010;4(4):262-7. [Crossref]  [PubMed]  [PMC] 
  19. Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, et al. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol. 2016;15(5):455-532. [Crossref] 
  20. Bird TD. Alzheimer's disease and other primary dementias. In: Braunwald E, Fauci AS, Kasper DL, Hauser K, Longo DL, Jameson JL, eds. Harrison's Manual of Medicine. 15th ed. USA: McGraw Hill Professional; 2001. p.2391-9.
  21. Wang G, Cheng Q, Zhang S, Bai L, Zeng J, Cui PJ, et al. Economic impact of dementia in developing countries: an evaluation of Alzheimer-type dementia in Shanghai, China. J Alzheimers Dis. 2008;15(1):109-15. [Crossref]  [PubMed] 
  22. Çınar N. [Epidemiology and clinical findings in Alzheimer's disease]. Turkiye Klinikleri J Neurol-Special Topics. 2012;5(3):1-6.
  23. Torun SD, Şalva T. [Socioeconomic burden of Alzheimer's disease]. Turkiye Klinikleri J Neurol-Special Topics. 2012;5(3):94-6.
  24. Winblad B, Wimo A, Almkvist O. Outcome measures in Alzheimer's disease: do they go far enough? Dement Geriatr Cogn Dis. 2000;11 Suppl 1:3-10. [Crossref]  [PubMed] 
  25. Winblad B, Wimo A. Assessing the societal impact of acetylcholinesterase inhibitor therapies. Alzheimer Dis Assoc Disord. 1999;13 Suppl 2:S9-19. [Crossref] 
  26. Neumann PJ. Health utilities in Alzheimer's disease and implications for cost-effectiveness analysis. Pharmacoeconomics. 2005;23(6):537-41. [Crossref]  [PubMed] 
  27. Neumann PJ, Araki SS, Arcelus A, Longo A, Papadopoulos G, Kosik KA, et al. Measuring Alzheimer's disease progression with transition probabilities: estimates from CERAD. Neurology. 2001;57(6):957-64. [Crossref]  [PubMed] 
  28. Phillips CJ. Health Economics: An Introduc­tion For Health Professionals. 1st ed. Massa­chusetts: Blackwell Publishing; 2005. [Crossref] 
  29. Ertekin A, Demir R, Özdemir G, Özel L, Özyıldırım E, Ulvi H. An investigation of the risk factors and prevalence of Alzheimer's disease in the eastern region of Turkey: a population based door-to-door survey. Eur J Gen Med. 2015;12(2):144-51. [Crossref] 
  30. Eroymak S, Yiğit V. [Cost analysis of Alzheimer's disease]. Journal of Suleyman Demirel University Institute of Social Sciences. 2017;29(4):167-96.
  31. Zencir M, Kuzu N, Beşer NG, Ergin A, Catak B, Sahiner T. Cost of Alzheimer's disease in a developing country setting. Int J Geriatr Psychiatry. 2005;20(7):616-22. [Crossref]  [PubMed] 
  32. Neumann PJ, Hermann RC, Kuntz KM, Araki SS, Duff SB, Leon J, et al. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease. Neurology. 1999;52(6):1138-45. [Crossref]  [PubMed] 
  33. Jones RW, McCrone PA, 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. [Crossref]  [PubMed] 
  34. Wolfson C, Oremus M, Shukla V, Momoli F, Demers L, Perrault A, et al. Donepezil and rivastigmine in the treatment of Alzheimer's disease: a best-evidence synthesis of the published data on their efficacy and cost-effectiveness. Clin Ther. 2002;24(6):862-86. [Crossref] 
  35. Loveman E, Green C, Kirby J, Taked A, Picot J, Payne E, et al. The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technol Assess. 2006;1(10). [Crossref]  [PubMed] 
  36. 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. [Crossref]  [PubMed] 
  37. 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. [Crossref]  [PubMed] 
  38. 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. [Crossref]  [PubMed]  [PMC] 
  39. 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. [Crossref]  [PubMed]  [PMC] 
  40. Knapp M, King D, Romeo R, Adams J, Baldwin A, Ballard C, et al. Cost‐effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO‐AD trial). Int J Geriatr Psychiatry. 2017;32(12):1205-16. [Crossref]  [PubMed]  [PMC] 
  41. da Silva LR, Vianna CMM, Mosegui GBG, Peregrino AAF, Marinho V, Laks J. Cost-effectiveness analysis of the treatment of mild and moderate Alzheimer's disease in Brazil. Braz J Psychiatry. 2019;41(3):218-24. [Crossref]  [PubMed]  [PMC] 
  42. Zala D, Chan D, McCrone P. The cost‐effectiveness implications of suboptimal treatment for different severities of Alzheimer's disease in the UK. Int J Geriatr Psychiatry. 2018;33(2):307-15. [Crossref]  [PubMed] 
  43. Weimer DL, Sager MA. Early identification and treatment of Alzheimer's disease: social and fiscal outcomes. Alzheimers Dement. 2009;5(3):215-26. [Crossref]  [PubMed]  [PMC] 
  44. 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. [Crossref]  [PubMed] 
  45. Getsios D, Blume S, Ishak KJ, Maclaine G, Hernández L. An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom. Alzheimers Dement. 2012;8(1):22-30. [Crossref]  [PubMed] 
  46. Barnett JH, Lewis L, Blackwell AD, Taylor M. Early intervention in Alzheimer's disease: a health economic study of the effects of diagnostic timing. BMC Neurol. 2014;14:104. [Crossref]  [PubMed]  [PMC] 

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