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The worldwide costs of dementia
Abstracts: Clinical Assessment, Policy, and Ethics / 1 (Suppl 1) (2005) fications of these were generated by matrix-assisted laser desorption ionization time of flight MS, and conclusive protein identifications accomplished by liquid chromatography-tandem MS. Conclusions: Several proteins were reproducibly quantitatively affected by GSE in rat brain, either in abundance, or in isoform complexity. The majority were “old” proteins, i.e. those that had been shown to be differentially expressed in AD or transgenic mouse models of dementia (i.e. creatine kinase brain beta chain, glial fibrillary acidic protein). Because the direction of change for most proteins affected by GSE in the normal healthy rats was opposite to that in AD or transgenic demented mouse brain, administration of GSE to healthy adults to protect critical proteins may be a strategy for prevention of AD. O2-03-08
COMMUNITY OF CARING: A CONTINUUM OF NORMALIZED EVIDENCE-BASED PROGRAMS TO MAINTAIN FUNCTION
Linda L. Buettner, Suzanne Fitzsimmons; Florida Gulf Coast University, Port Charlotte, FL, USA Background: The Community of Caring is a model program funded by the state of Florida in the most elderly county in the nation. The Florida Gulf Coast University Center for Positive Aging research team designed this continuum to meet the needs of the entire community beginning with intergerational service-based education, continuing into programs aimed at identifying people worried about their memories and then maintaining cognitive skills and physical skills for those with a dementia diagnosis. The team provides therapeutic recreation clubs for people with moderate to severe impairments, teaches college classes for people with new diagnoses, and has established numerous other normalized programs and services based on intervention research findings. Timing of the programs and services is as important as the content. One hundred families have been followed and supported in this program for over a year with highly significant outcomes. Objective(s): 1. Provide specific dementia education-service programs in the local schools. 2. Use innovative case finding methods to reach clients. 3. Design and test continuum components to enhance function and reduce stigma. 4. Use a community toolbox planning approach to gain community-wide support. Methods: This innovative continuum of programs and services focuses on cognitive health and maximizing function in older adult families. The Center for Positive Aging provides a dynamic linkage between research-based intervention studies and our community’s needs. Baseline assessments help the team advise clients about program selection and there is no gap between memory concerns, diagnosis, and programs and services to maintain abilities.Our families are not isolated or stigmatized but are engaged in a rich and varied set of programs designed like college classes and exciting experiences. The first year’s outcomes have been dramatic and positive for the community and the families involved. 2. Conclusions: Stigma free memory based programs and services tested in Charlotte County FL have successfully integrated people with memory loss into the community and helped older adult families retain physical, cognitive, and psychosocial function. This model program could help communities nationwide maintain members with memory loss in their homes.
Objective(s): To estimate the worldwide costs of dementia. Methods: The worldwide costs of dementia were estimated from prevalence figures for different regions, cost-of-illness studies from key countries using a model based on the relationship between direct costs of care per demented and the gross domestic product (GDP) per capita in each country. In a sensitivity analysis, several alternative calculation methods are explored and compared. Conclusions: The worldwide direct costs for dementia in 2003 are estimated at 156 billion US$ in the main scenario based on a worldwide prevalence of 27.7 million demented. The range in the sensitivity analysis was 129-159 billion US$. Ninety-two per cent of the costs are found in the advanced economies with 38% of the prevalence. Due to several sources of uncertainty the range of cost estimates is relatively wide. Nevertheless, it is obvious that the worldwide costs are substantial and particularly the expected increase of elderly people in the developing countries present a great challenge for social and health care systems. O2-04-02
O2-04-01
THE WORLDWIDE COSTS OF DEMENTIA
Bengt Winblad, Linus Jo¨nsson, Anders Wimo. Neurotec, Karolinska Institutet, Sweden Background: Dementia disorders are considered to be a major driver of the costs in the health care and social systems in the developed countries. However, the majority of the demented live in the developing countries. Thus it is of interest for policy makers how costs of dementia are distributed worldwide.
THE ECONOMICS AND PHARMACOECONOMICS OF MILD COGNITIVE IMPAIRMENT
Howard Fillit, Jerrold Hill; Institute for the Study of Aging, New York, NY, USA Background: Previous research demonstrated the excess economic costs of Alzheimer’s disease and related dementias, and the potential causes of excess costs such as cognitive impairment in elderly with common medical comorbidities. As an emerging area of investigation, there have been few studies of the economic impact of mild cognitive impairment (MCI). Yet worldwide, regulatory agencies and payors are increasingly requiring pharmacoeconomic outcomes for approval and formulary payment. Therapeutics being developed for MCI especially face considerable regulatory barriers. MCI may be viewed by regulatory agencies and payors either as a prodrome to Alzheimer’s disease that may not warrant a separate indication, or as a “quality of life” syndrome without significant societal impact. Thus, demonstrating pharmacoeconomic outcomes is particularly problematic and especially important in MCI. Defining the economics of MCI and demonstrating pharmacoeconomic outcomes may be critical to convincing regulatory agencies and payors of the individual and societal importance of MCI and the value of therapeutics to treat MCI. Objectives: To present a framework for economic and pharmacoeconomic studies of MCI. Methods: Previous economic studies relevant to MCI will be reviewed. An investigative basis for economic and pharmacoeconomic studies in MCI will be discussed. The potential economic value of slowing progression to dementia will be outlined. Specific challenges and opportunities in study designs for modeling and studying cost-effectiveness using administrative data and surveys will be reviewed. Study designs for pharmacoeconomic outcomes in clinical trials of MCI will be outlined. Economic variables unique to MCI, such as the effect of “mild” functional impairment and diminished capacity to effectively manage higher order activities of daily living; the potential impact of MCI on worker productivity; and the effect of MCI on the management and costs of comorbidities in disease management will be discussed. Conclusions: For drug development in MCI, it is vital to demonstrate the economic burden of MCI to society and the pharmacoeconomic value of therapeutics to treat MCI in order to achieve regulatory approval, formulary payment and market acceptance. O2-04-03
MONDAY, JUNE 20, 2005 ORAL O2-04 CLINICAL ASSESSMENT, POLICY AND ETHICS
S101
THE REVEAL STUDY: THE IMPACT OF GENETIC RISK ASSESSMENT WITH APOE DISCLOSURE FOR ALZHEIMER’S DISEASE
Robert C. Green1, Scott Roberts1, Adrienne Cupples2, Cathleen Zick3, Peter Whitehouse4, Norman Relkin5; 1Boston University School of Medicine, Boston, MA, USA; 2Boston University School of Public Health, Boston, MA, USA; 3University of Utah, Salt Lake City, UT, USA; 4Case University School of Medicine, Cleveland, OH, USA; 5Weill Medical College of Cornell University, New York, NY, USA Background: Apolipoprotein E (APOE) genotype is the most robust risk marker for AD, but has not been used for risk assessment because of concerns about misunderstanding, safety and discrimination after disclo-
COMMUNITY OF CARING: A CONTINUUM OF NORMALIZED EVIDENCE-BASED PROGRAMS TO MAINTAIN FUNCTION
Linda L. Buettner, Suzanne Fitzsimmons; Florida Gulf Coast University, Port Charlotte, FL, USA Background: The Community of Caring is a model program funded by the state of Florida in the most elderly county in the nation. The Florida Gulf Coast University Center for Positive Aging research team designed this continuum to meet the needs of the entire community beginning with intergerational service-based education, continuing into programs aimed at identifying people worried about their memories and then maintaining cognitive skills and physical skills for those with a dementia diagnosis. The team provides therapeutic recreation clubs for people with moderate to severe impairments, teaches college classes for people with new diagnoses, and has established numerous other normalized programs and services based on intervention research findings. Timing of the programs and services is as important as the content. One hundred families have been followed and supported in this program for over a year with highly significant outcomes. Objective(s): 1. Provide specific dementia education-service programs in the local schools. 2. Use innovative case finding methods to reach clients. 3. Design and test continuum components to enhance function and reduce stigma. 4. Use a community toolbox planning approach to gain community-wide support. Methods: This innovative continuum of programs and services focuses on cognitive health and maximizing function in older adult families. The Center for Positive Aging provides a dynamic linkage between research-based intervention studies and our community’s needs. Baseline assessments help the team advise clients about program selection and there is no gap between memory concerns, diagnosis, and programs and services to maintain abilities.Our families are not isolated or stigmatized but are engaged in a rich and varied set of programs designed like college classes and exciting experiences. The first year’s outcomes have been dramatic and positive for the community and the families involved. 2. Conclusions: Stigma free memory based programs and services tested in Charlotte County FL have successfully integrated people with memory loss into the community and helped older adult families retain physical, cognitive, and psychosocial function. This model program could help communities nationwide maintain members with memory loss in their homes.
Objective(s): To estimate the worldwide costs of dementia. Methods: The worldwide costs of dementia were estimated from prevalence figures for different regions, cost-of-illness studies from key countries using a model based on the relationship between direct costs of care per demented and the gross domestic product (GDP) per capita in each country. In a sensitivity analysis, several alternative calculation methods are explored and compared. Conclusions: The worldwide direct costs for dementia in 2003 are estimated at 156 billion US$ in the main scenario based on a worldwide prevalence of 27.7 million demented. The range in the sensitivity analysis was 129-159 billion US$. Ninety-two per cent of the costs are found in the advanced economies with 38% of the prevalence. Due to several sources of uncertainty the range of cost estimates is relatively wide. Nevertheless, it is obvious that the worldwide costs are substantial and particularly the expected increase of elderly people in the developing countries present a great challenge for social and health care systems. O2-04-02
O2-04-01
THE WORLDWIDE COSTS OF DEMENTIA
Bengt Winblad, Linus Jo¨nsson, Anders Wimo. Neurotec, Karolinska Institutet, Sweden Background: Dementia disorders are considered to be a major driver of the costs in the health care and social systems in the developed countries. However, the majority of the demented live in the developing countries. Thus it is of interest for policy makers how costs of dementia are distributed worldwide.
THE ECONOMICS AND PHARMACOECONOMICS OF MILD COGNITIVE IMPAIRMENT
Howard Fillit, Jerrold Hill; Institute for the Study of Aging, New York, NY, USA Background: Previous research demonstrated the excess economic costs of Alzheimer’s disease and related dementias, and the potential causes of excess costs such as cognitive impairment in elderly with common medical comorbidities. As an emerging area of investigation, there have been few studies of the economic impact of mild cognitive impairment (MCI). Yet worldwide, regulatory agencies and payors are increasingly requiring pharmacoeconomic outcomes for approval and formulary payment. Therapeutics being developed for MCI especially face considerable regulatory barriers. MCI may be viewed by regulatory agencies and payors either as a prodrome to Alzheimer’s disease that may not warrant a separate indication, or as a “quality of life” syndrome without significant societal impact. Thus, demonstrating pharmacoeconomic outcomes is particularly problematic and especially important in MCI. Defining the economics of MCI and demonstrating pharmacoeconomic outcomes may be critical to convincing regulatory agencies and payors of the individual and societal importance of MCI and the value of therapeutics to treat MCI. Objectives: To present a framework for economic and pharmacoeconomic studies of MCI. Methods: Previous economic studies relevant to MCI will be reviewed. An investigative basis for economic and pharmacoeconomic studies in MCI will be discussed. The potential economic value of slowing progression to dementia will be outlined. Specific challenges and opportunities in study designs for modeling and studying cost-effectiveness using administrative data and surveys will be reviewed. Study designs for pharmacoeconomic outcomes in clinical trials of MCI will be outlined. Economic variables unique to MCI, such as the effect of “mild” functional impairment and diminished capacity to effectively manage higher order activities of daily living; the potential impact of MCI on worker productivity; and the effect of MCI on the management and costs of comorbidities in disease management will be discussed. Conclusions: For drug development in MCI, it is vital to demonstrate the economic burden of MCI to society and the pharmacoeconomic value of therapeutics to treat MCI in order to achieve regulatory approval, formulary payment and market acceptance. O2-04-03
MONDAY, JUNE 20, 2005 ORAL O2-04 CLINICAL ASSESSMENT, POLICY AND ETHICS
S101
THE REVEAL STUDY: THE IMPACT OF GENETIC RISK ASSESSMENT WITH APOE DISCLOSURE FOR ALZHEIMER’S DISEASE
Robert C. Green1, Scott Roberts1, Adrienne Cupples2, Cathleen Zick3, Peter Whitehouse4, Norman Relkin5; 1Boston University School of Medicine, Boston, MA, USA; 2Boston University School of Public Health, Boston, MA, USA; 3University of Utah, Salt Lake City, UT, USA; 4Case University School of Medicine, Cleveland, OH, USA; 5Weill Medical College of Cornell University, New York, NY, USA Background: Apolipoprotein E (APOE) genotype is the most robust risk marker for AD, but has not been used for risk assessment because of concerns about misunderstanding, safety and discrimination after disclo-