Skip to main content Accessibility help
×
Home

Where are we at with model-based economic evaluations of interventions for dementia? a systematic review and quality assessment

  • Kim-Huong Nguyen (a1) (a2), Tracy A. Comans (a1) (a2) and Colin Green (a3)

Abstract

Objective:

To identify, review, and critically appraise model-based economic evaluations of all types of interventions for people with dementia and their carers.

Design:

A systematic literature search was undertaken to identify model-based evaluations of dementia interventions. A critical appraisal of included studies was carried out using guidance on good practice methods for decision-analytic models in health technology assessment, with a focus on model structure, data, and model consistency.

Setting:

Interventions for people with dementia and their carers, across prevention, diagnostic, treatment, and disease management.

Results:

We identified 67 studies, with 43 evaluating pharmacological products, 19 covering prevention or diagnostic strategies, and 5 studies reporting non-pharmacological interventions. The majority of studies use Markov models with a simple structure to represent dementia symptoms and disease progression. Half of all studies reported taking a societal perspective, with the other half adopting a third-party payer perspective. Most studies follow good practices in modeling, particularly related to the decision problem description, perspective, model structure, and data inputs. Many studies perform poorly in areas related to the reporting of pre-modeling analyses, justifying data inputs, evaluating data quality, considering alternative modeling options, validating models, and assessing uncertainty.

Conclusions:

There is a growing literature on the model-based evaluations of interventions for dementia. The literature predominantly reports on pharmaceutical interventions for Alzheimer's disease, but there is a growing literature for dementia prevention and non-pharmacological interventions. Our findings demonstrate that decision-makers need to critically appraise and understand the model-based evaluations and their limitations to ensure they are used, interpreted, and applied appropriately.

Copyright

Corresponding author

Correspondence should be addressed to: Kim-Huong Nguyen, Centre for Health Services Research, The University of Queensland, Building 33, PAH, Woolloongabba, Brisbane, Queensland 4102, Australia. Phone: (+61) 07 3176 4593; Email: kim.h.nguyen@uq.edu.au.

References

Hide All
Bermingham, S. (2014). The appropriate use of neuroimaging in the diagnostic work-up of dementia. Ontario Health Technology Assessment Series, 14, 167.
Biasutti, M., Dufour, N., Ferroud, C., Dab, W. and Temime, L. (2012). Cost-effectiveness of magnetic resonance imaging with a new contrast agent for the early diagnosis of Alzheimer's disease. PLoS One, 7, e35559. https://doi.org/10.1371/journal.pone.0035559
Birks, Jacqueline S. (2006). Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database of Systematic Reviews. Chichester, UK: The Cochrane Collaboration. https://doi.org/10.1002/14651858.CD005593
Bond, M. et al. (2012). The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No. 111): a systematic review and economic model. Health Technology Assessment, 16. https://doi.org/10.3310/hta16210
Budd, D., Burns, Guo and L'Italien, Lapuerta (2011). Impact of early intervention and disease modification in patients with predementia Alzheimer's disease: a Markov model simulation. ClinicoEconomics and Outcomes Research, 189195. https://doi.org/10.2147/CEOR.S22265
Caro, J. J., Briggs, A. H., Siebert, U. and Kuntz, K. M. (2012). Modeling good research practices—overview: a report of the ISPOR-SMDM modeling good research practices task force–1. Medical Decision Making, 32, 667677. https://doi.org/10.1177/0272989X12454577
Caro, J. J. et al. (2001). Assessment of health economics in Alzheimer's disease (AHEAD) based on need for full-time care. Neurology, 57, 964971.
Cohen, J. T. and Neumann, P. J. (2008). Decision analytic models for Alzheimer's disease: state of the art and future directions. Alzheimer's & Dementia, 4, 212222. https://doi.org/10.1016/j.jalz.2008.02.003
Djalalov, S. et al. (2012). Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: an exploratory economic evaluation of personalized medicine. Molecular Diagnosis & Therapy, 16, 389399. https://doi.org/10.1007/s40291-012-0010-7
Dowd, W. N. et al. (2018). An exploratory cost-effectiveness analysis of the connected health intervention to improve care for people with dementia: a simulation analysis. Health Services and Outcomes Research Methodology, 18, 4762. https://doi.org/10.1007/s10742-017-0175-y
Ekman, M., Berg, J., Wimo, A., Jönsson, L. and McBurney, C. (2007). Health utilities in mild cognitive impairment and dementia: a population study in Sweden. International Journal of Geriatric Psychiatry, 22, 649655. https://doi.org/10.1002/gps.1725
Fuh, J.-L. and Wang, S.-J. (2008). Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer's disease in Taiwan. International Journal of Geriatric Psychiatry, 23, 7378. https://doi.org/10.1002/gps.1842
Gagnon, M., Rive, B., Hux, M. and Guilhaume, C. (2007). Cost-effectiveness of memantine compared with standard care in moderate-to-severe Alzheimer disease in Canada. The Canadian Journal of Psychiatry, 52, 519–26.
Getsios, D., Blume, S., Ishak, K. J. and Maclaine, G. D. H. (2010). Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer's disease: a UK evaluation using discrete-event simulation. PharmacoEconomics, 28, 411427. https://doi.org/10.2165/11531870-000000000-00000
Getsios, D., Blume, S., Ishak, K. J., MacLaine, G. and Hernández, L. (2012). An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom. Alzheimer's & Dementia, 8, 2230. https://doi.org/10.1016/j.jalz.2010.07.001
Green, C. (2007). Modelling disease progression in Alzheimer's disease. PharmacoEconomics, 25, 735750.
Green, C., Shearer, J., Ritchie, C. W. and Zajicek, J. P. (2011). Model-Based economic evaluation in Alzheimer's disease: a review of the methods available to model Alzheimer's disease progression. Value Health, 14, 621630. https://doi.org/10.1016/j.jval.2010.12.008
Green, C. and Zhang, S. (2016). Predicting the progression of Alzheimer's disease dementia: a multidomain health policy model. Alzheimer's & Dementia, 12, 776–785. https://doi.org/10.1016/j.jalz.2016.01.011.
Gustavsson, A., Van Der Putt, R., Jönsson, L. and McShane, R. (2009). Economic evaluation of cholinesterase inhibitor therapy for dementia: comparison of Alzheimer's disease and Dementia with Lewy bodies. International Journal of Geriatric Psychiatry, 24, 10721078. https://doi.org/10.1002/gps.2223
Handels, R. L. H., Wolfs, C. A. G., Aalten, P., Joore, M. A., Verhey, F. R. J. and Severens, J. L. (2014). Diagnosing Alzheimer's disease: a systematic review of economic evaluations. Alzheimer's & Dementia, 10, 225237. https://doi.org/10.1016/j.jalz.2013.02.005
Hartz, S., Getsios, D., Tao, S., Blume, S. and Maclaine, G. (2012). Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer's disease in Germany using discrete event simulation. BMC Neurology, 12, 2. https://doi.org/10.1186/1471-2377-12-2
Henke, C. and Burchmore, M. (1997). The economic impact of Tacrine in the treatment of Alzheimer's disease. Clinical Therapeutic, 9, 330–345.
Hernandez, L., Ozen, A., DosSantos, R. and Getsios, D. (2016). Systematic review of model-based economic evaluations of treatments for Alzheimer's disease. PharmacoEconomics, 34, 681707. https://doi.org/10.1007/s40273-016-0392-1
Hu, S., Yu, X., Chen, S., Clay, E., Toumi, M. and Milea, D. (2015). Memantine for treatment of moderate or severe Alzheimer's disease patients in urban China: clinical and economic outcomes from a health economic model. Expert Review of Pharmacoeconomics & Outcomes Research, 15, 565578. https://doi.org/10.1586/14737167.2015.1065734
Ikeda, S., Niwata, S. and Igarashi, Y. (2001). Evaluating QoL of elderly people with dementia. Japanese Journal of Pharmacoepidemiology, 5, 99105.
Jones, C., Edwards, R. T. and Hounsome, B. (2012). Health economics research into supporting carers of people with dementia: a systematic review of outcome measures. Health and Quality of Life Outcomes, 10, 1.
Jones, R. W., McCrone, P. and Guilhaume, C. (2004). Cost effectiveness of memantine in Alzheimer's disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging, 21, 607620. https://doi.org/10.2165/00002512-200421090-00005
Jonsson, L. (2005). Cost-effectiveness of memantine for moderate to severe Alzheimer's disease in Sweden. The American Journal of Geriatric Pharmacotherapy, 3, 7786. https://doi.org/10.1016/j.amjopharm.2005.05.002
Jonsson, L. et al. (2006). Patient-and proxy-reported utility in Alzheimer disease using the EuroQoL. Alzheimer Disease & Associated Disorders, 20, 4955.
Jonsson, L., Lindgren, P., Wimo, A., Jonsson, B. and Winblad, B. (1999). The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer's disease: a Markov model. Clinical Therapeutics, 21, 12301240. https://doi.org/10.1016/S0149-2918(00)80025-9
Kirbach, S., Simpson, K., Nietert, P. J. and Mintzer, J. (2008). A markov model of the cost effectiveness of olanzapine treatment for agitation and psychosis in Alzheimer's disease. Clinical Drug Investigation, 28, 291303. https://doi.org/10.2165/00044011-200828050-00003
Lachaine, J., Beauchemin, C., Legault, M. and Bineau, S. (2011). Economic evaluation of the impact of memanine on time to nursing home admission in the treatment of Alzhiemer disease. The Canadian Journal of Psychiatry, 56, 596–604.
Lee, S. A. W., Sposato, L. A., Hachinski, V. and Cipriano, L. E. (2017). Cost-effectiveness of cerebrospinal biomarkers for the diagnosis of Alzheimer's disease. Alzheimer's Research & Therapy, 9, 18. https://doi.org/10.1186/s13195-017-0243-0
Lopez-Bastida, J., Serrano-Aguilar, P., Perestelo-Perez, L. and Oliva-Moreno, J. (2006). Social-economic costs and quality of life of Alzheimer disease in the Canary Islands, Spain. Neurology, 67, 21862191. https://doi.org/10.1212/01.wnl.0000249311.80411.93
Loveman, E. et al. (2006). The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technology Assessment in England and Wales, 10, iii–iv, ix–xi, 1160.
Martikainen, J., Valtonen, H. and Pirttila, T. (2004). Potential cost-effectiveness of a family-based program in mild Alzheimer's disease patients. The European Journal of Health Economics, 5, 136142.
Mirsaeedi-Farahani, K., Halpern, C. H., Baltuch, G. H., Wolk, D. A., and Stein, S. C. (2015). Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis. Journal of Neurology, 262, 11911197. https://doi.org/10.1007/s00415-015-7688-5
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. and PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 151, 264269, W64.
Morris, J. C. et al. (1989). The consortium to establish a registry for Alzheimer's disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 11591165.
Neumann, P. J. et al. (1999). Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease. Neurology, 52, 11381145.
Neumann, P., Hermann, R. C. and Weistein, M. (1998). Measuring QALYs in dementia. In A. Wimo, B. Jönsson, G. Karlsson, and B. Winblad (eds.), Health Economics of Dementia (pp. 359–370). Sussex, UK: John Wiley & Sons, Inc.
Neumann, Peter J. et al. (1999). Health utilities in Alzheimer's disease: a cross-sectional study of patients and caregivers. Medical Care, 37, 2732.
O'Brien, B. J. et al. (1999). Economic evaluation of donepezil for the treatment of Alzheimer's disease in Canada. Journal of the American Geriatrics Society, 47, 570578.
Oremus, M. (2008). Systematic review of economic evaluations of Alzheimer's disease medications. Expert Review of Pharmacoeconomics & Outcomes Research, 8, 273289. https://doi.org/10.1586/14737167.8.3.273
Peters, J. L., Anderson, R., Hoyle, M. and Hyde, C. (2013). Evolution of a cost utility model of donepezil for Alzheimer's disease. International Journal of Technology Assessment in Health Care, 29, 147154. https://doi.org/10.1017/S026646231300007X
Philips, Z., Bojke, L., Sculpher, M., Claxton, K. and Golder, S. (2006). Good practice guidelines for decision-analytic modelling in health technology assessment. PharmacoEconomics, 24, 355371. https://doi.org/10.2165/00019053-200624040-00006
Philips, Z., Ginnelly, L., Sculpher, M., Claxton, K. and Golder, S. (2004). Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technology Assessment, 8.
Prince, M., Albanese, E., Guerchet, M. and Prina, M. (2014). Dementia and risk reduction: an analysis of protective and modifiable factors. World Alzheimer Report. Alzheimer's Disease International (ADI), London, UK.
Retchin, S. M. and Hillner, B. E. (1994). The costs and benefits of a screening program to detect dementia in older drivers. Medical Decision Making, 14, 315324.
Rive, B. et al. (2010). Cost effectiveness of memantine in Alzheimer's disease in the UK. Journal of Medical Economics, 13, 371380. https://doi.org/10.3111/13696998.2010.491347
Rogers, S., Farlow, M., Doody, R., Mohs, R., Friedhoff, T. and Donepezil Study Group (1998). A 24-week, double-blind, placebocontrolled trial of donepezil in patients with Alzheimer's disease. Neurology, 50, 137.
Rowen, D. et al. (2012). Estimating preference-based single index measures for dementia using DEMQOL and DEMQOL-Proxy. Value Health, 15, 346356. https://doi.org/10.1016/j.jval.2011.10.016
Skoldunger, A., Johnell, K., Winblad, B. and Wimo, A. (2013). Mortality and treatment costs have a great impact on the cost-effectiveness of disease modifying treatment in Alzheimer's disease–a simulation study. Current Alzheimer Research, 10, 207216.
Sopina, E. and Sørensen, J. (2018). Decision modelling of non-pharmacological interventions for individuals with dementia: a systematic review of methodologies. Health Economics Review, 8. https://doi.org/10.1186/s13561-018-0192-8
Stern, Y. et al. (1997). Predicting time to nursing home care and death in individuals with Alzheimer disease. JAMA, 277, 806812.
Teipel, S. J., Ewers, M., Reisig, V., Schweikert, B., Hampel, H. and Happich, M. (2007). Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease. European Archives of Psychiatry and Clinical Neuroscience, 257, 330336. https://doi.org/10.1007/s00406-007-0727-1
Thibault, C. et al. (2015). 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. Journal of Medical Economics, 18, 930943. https://doi.org/10.3111/13696998.2015.1063501
Touchon, J., Lachaine, J., Beauchemin, C., Granghaud, A., Rive, B. and Bineau, S. (2014). 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. The European Journal of Health Economics, 15, 791800. https://doi.org/10.1007/s10198-013-0523-y
Weinstein, M. C. et al. (2003). Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR task force on good research practices—modeling studies. Value Health, 6, 917. https://doi.org/10.1046/j.1524-4733.2003.00234.x
Wong, C. L., Bansback, N., Lee, P. E. and Anis, A. H. (2009). Cost-Effectiveness: cholinesterase inhibitors and memantine in vascular dementia. Canadian Journal of Neurological Sciences, 36, 735739.
Yang, K.-C. and Chen, H.-H. (2016). Probabilistic cost-effectiveness analysis of vaccination for mild or moderate Alzheimer's disease. Current Alzheimer Research, 13, 809816.
Yu, S.-Y., Lee, T.-J., Jang, S.-H., Han, J.W., Kim, T. H. and Kim, K. W. (2015). Cost-Effectiveness of nationwide opportunistic screening program for dementia in South Korea. Journal of Alzheimer's Disease, 44, 195204.
Zhang, Y., Kivipelto, M., Solomon, A. and Wimo, A. (2011). Cost-effectiveness of a health intervention program with risk reductions for getting demented: results of a markov model in a Swedish/Finnish setting. Journal of Alzheimer's Disease, 26, 735744. https://doi.org/10.3233/JAD-2011-110065

Keywords

Type Description Title
WORD
Supplementary materials

Nguyen et al. supplementary material
Appendices 1 and 2

 Word (560 KB)
560 KB

Where are we at with model-based economic evaluations of interventions for dementia? a systematic review and quality assessment

  • Kim-Huong Nguyen (a1) (a2), Tracy A. Comans (a1) (a2) and Colin Green (a3)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed