Abstract
Background:For care planning and support, under-detection and late diagnosis of Alzheimer’s disease (AD) is a great challenge. Models of Patient-Engagement for Alzheimer’s Disease (MOPEAD) is an EU-funded project aiming at testing different strategies to improve this situation.Objective:To make a cost-consequence analysis of MOPEAD.Methods:Four screening strategies were tested in five countries (Germany, the Netherlands, Slovenia, Spain, and Sweden): 1) a web-approach; 2) Open-House initiative; 3) in primary care; and 4) by diabetes specialists. Persons-at-risk of AD in all strategies were offered referral to a hospital-based specialist. The primary health-economic outcome was the cost per true-positive case (TP) of AD from the screened population.Results:Of 2,847 screened persons, 1,121 screened positive (39%), 402 were evaluated at memory clinics (14%), and 236 got an AD diagnosis (8%). The cost per TP of those screened was €3,115 with the web-approach, €2,722 with the Open-House, €1,530 in primary care, and €1,190 by diabetes specialists. Sensitivity analyses that more likely reflect the real-world situation confirmed the results. The number-needed-to-screen was 30 with the web-approach, 8 with the Open-House and primary care, and 6 with the diabetes specialists.There were country differences in terms of screening rates, referrals to memory clinics, staff-types involved, and costs per TP.Conclusion:In primary care and by the diabetes specialist, the costs per TP/screened population were lowest, but the capacity of such settings to identify cases with AD-risk must be discussed. Hence new diagnostic strategies such as web-solutions and Open-House initiatives may be valuable after modifications.
Highlights
In 2015, Prince et al suggested that dementia would affect about 50 million people worldwide today [1]
Run 1 screened the greatest number of people but had the lowest attendance rate to the full diagnostic at memory clinics (WP3), and the lowest proportion of true positive (TP)
Using MOPEAD’s explorative and innovative approach for testing the costs and consequences of identification of hidden mild cognitive impairment (MCI)-due-to-Alzheimer’s disease (AD) and AD dementia persons, we found large variability across Europe and in the different pre-screening runs
Summary
In 2015, Prince et al suggested that dementia would affect about 50 million people worldwide today [1]. The economic and social costs could pose a threat to public health, to an extent that has led the World Health Organization to declare dementia control a global health priority [3]. Methods: Four screening strategies were tested in five countries (Germany, the Netherlands, Slovenia, Spain, and Sweden): 1) a web-approach; 2) Open-House initiative; 3) in primary care; and 4) by diabetes specialists. The cost per TP of those screened was D 3,115 with the web-approach, D 2,722 with the OpenHouse, D 1,530 in primary care, and D 1,190 by diabetes specialists. The number-needed-to-screen was 30 with the web-approach, 8 with the Open-House and primary care, and 6 with the diabetes specialists. Conclusion: In primary care and by the diabetes specialist, the costs per TP/screened population were lowest, but the capacity of such settings to identify cases with AD-risk must be discussed. New diagnostic strategies such as web-solutions and Open-House initiatives may be valuable after modifications
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