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The economic impact of neuropsychiatric symptoms in Alzheimer’s disease

Can drugs ease the burden?

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Abstract

The majority of patients with Alzheimer’s disease (AD) will have clinically significant neuropsychiatric symptoms during the course of their disease. There is growing evidence that neuropsychiatric symptoms increase direct costs of care in patients with AD, especially the costs associated with formal long-term care and unpaid caregiving. For example, we have estimated that a 1-point worsening of the neuropsychiatric inventory score is associated with an incremental increase of between $US247 and $US409 per year in total direct costs of care based upon year 2001 US dollars, depending on the value of unpaid caregiving.

Although data are still limited, there have been a series of well designed, controlled clinical trials that have established the efficacy of several drugs used in the treatment of neuropsychiatric symptoms in patients with AD. The economic impact of using efficacious drugs to treat neuropsychiatric symptoms in patients with AD has not been evaluated formally. To successfully complete formal economic evaluations of these drugs there is a need for more research to refine methods for determining the economic value of unpaid caregiving and to collect more data concerning the incremental effects of neuropsychiatric symptoms on QOL, costs of care and survival. The current ongoing treatment trials that are collecting economic and QOL data as a part of the trial will be able to perform cost-effectiveness and cost-utility analyses of these new efficacious drugs. These economic evaluations will provide important information for decision makers who are formulating healthcare policy for the treatment of patients with AD.

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Acknowledgements

The National Institute on Aging Career Development Award, K08-AG00864, supported Dr Murman during preparation of this article.

The authors do not have any potential conflicts of interest relevant to the content of the manuscript. Dr Murman currently has research funding from the Alzheimer’s Association.

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Authors and Affiliations

  1. Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA

    Daniel L. Murman

  2. Department of Psychiatry and Behavioral Sciences, and Office of the Dean, Texas A & M University System Health Sciences Center, College Station, Texas, USA

    Christopher C. Colenda

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Correspondence to Daniel L. Murman.

Appendix

Appendix

1.1 Pharmacoeconomic Definitions

1.1.1 Costs

Costs are composed of both direct and indirect components.

Direct costs can be defined as the economic value of all goods, services and other resources ‘directly’ associated with the disease and its treatment.[73] These direct costs can be further subdivided into formal and informal direct costs. Formal direct costs are those disease-related costs in which payment is made for healthcare services (e.g. medications, physician visits, hospitalisation, paid home healthcare, nursing home care). Informal direct costs consist of the economic value of unpaid disease-related care activities.[48,51,52,65]

In addition to direct costs there are indirect costs associated with the inability to work, potentially applying to both the patient with AD and their caregivers. For example, if a patient with AD has to retire early because of their dementia, then their lost earnings would be considered an indirect cost.

1.1.2 Cost Effectiveness and Cost Utility

The two most commonly used economic evaluation approaches in medicine are cost-effectiveness and cost-utility analysis.[73] Both approaches compare the costs and outcomes associated with two alternative treatments, by calculating a cost to outcome ratio (i.e. [cost 1 − cost 2] ÷ [outcome 1 − outcome 2]).

In cost-effectiveness analysis health outcomes are left in their natural units (e.g. survival or disease-related scale) and treatments are compared by their cost per outcome (e.g. cost per year of life gained).

Cost-utility analysis is a variation of cost-effectiveness analysis that uses QALY as the outcome measure. A QALY is a composite measure that adjusts a person’s survival by their HR-QOL while they are living. The HR-QOL scales used to calculate QALYs are preference-weighted scales that generally place health on a continuum between zero (death) and one (perfect health). For example, if a patient with AD had a HR-QOL score of 0.5 and lived for 1 year, then their QALY would be 0.5 × 1 = 0.5 QALY.

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Murman, D.L., Colenda, C.C. The economic impact of neuropsychiatric symptoms in Alzheimer’s disease. Pharmacoeconomics 23, 227–242 (2005). https://doi.org/10.2165/00019053-200523030-00004

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