A Cost-Consequence Analysis of Different Screening Procedures in Alzheimer’s Disease: Results from the MOPEAD Project

Author:

Wimo Anders1,Belger Mark2,Bon Jaka3,Jessen Frank456,Dumas Annette7,Kramberger Milica G.8,Jamilis Laura9,Johansson Gunilla1,Rodrigo Salas Adrián9,Rodríguez Gómez Octavio10,Sannemann Lena4,Stoekenbroek Malou11,Gurruchaga Telleria Miren12,Valero Sergi1213,Vermunt Lisa11,Waterink Lisa11,Winblad Bengt114,Visser Peter Jelle11,Zwan Marissa11,Boada Mercè101213,

Affiliation:

1. Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden

2. Eli Lilly and Company Ltd (ELI), Bracknell, UK

3. University Medical Centre Ljubljana (UMCL), Ljubljana, Slovenia

4. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry, Cologne, Germany

5. Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) Universität zu Köln, Köln, Germany

6. Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Germany

7. ASDM Consulting, EU Affairs Director, Brussels, Belgium

8. Department of Neurology, University Medical Center Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

9. GMV Soluciones Globales Internet S.A.U. (GMV), Spain

10. Fundació ACE (FACE), Barcelona, Spain

11. Amsterdam UMC, VU University, Amsterdam, Amsterdam, the Netherlands

12. Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain

13. Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain

14. Karolinska University Hospital, Theme Inflammation and Aging, Huddinge, Sweden

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.

Publisher

IOS Press

Subject

Psychiatry and Mental health,Geriatrics and Gerontology,Clinical Psychology,General Medicine,General Neuroscience

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