PND44 EVALUATION OF THE EFFICIENCY OF FOUR PREVENTION STRATEGIES IN ALZHEIMER'S DISEASE: RESULTS FROM THE MULTIDOMAIN ALZHEIMER PREVENTIVE TRIAL (MAPT) STUDY

BACKGROUND: To date, no curative treatment is available for Alzheimer’s disease (AD). Therefore, efforts should focus on prevention strategies to improve the efficiency of healthcare systems. Objective: Our aim was to assess the cost-effectiveness of three preventive strategies for AD compared to a placebo. Design: The Multidomain Alzheimer Preventive Trial (MAPT) study was a multicenter, randomized, placebo-controlled superiority trial with four parallel groups, including three intervention groups (one group with Multidomain Intervention (MI) plus a placebo, one group with Polyunsaturated Fatty Acids (PFA), one group with a combination of PFA and MI) and one placebo group. Setting: Participants were recruited and included in 13 memory centers in France and Monaco. Participants: Community-dwelling subject aged 70 years and older were followed during 3 years. Interventions: We used data from the MAPT study which aims to test the efficacy of a MI along PFA, the MI plus a placebo, PFA alone, or a placebo alone. Measurement: Direct medical and non-medical costs were calculated from a payer’s perspective during the 3 years of follow-up. The base case incremental Cost-Effectiveness Ratio (ICER) represents the cost per improved cognitive Z-score point. Sensitivity analyses were performed using different interpretation of the effectiveness criteria. Results: Analyses were conducted on 1,525 participants. The ICER at year 3 that compares the MI + PFA and the MI alone to the placebo amounted to €21,443 and €21,543 respectively, per improved Z score point. PFA alone amounted to €111,720 per improved Z score point. Conclusion: Our study shows that ICERS of PFA combined with MI and MI alone amounted to €21,443 and €21,543 respectively per improved Z score point compared to the placebo and are below the WTP of €50,000 while the ICER of PFA alone amounted to €111,720 per improved Z score point. This information may help decision makers and serve as a basis for the implementation of a lifetime decision analytic model.

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Alzheimer’s Disease: New Data Highlight Nonneuronal Cell Types and the Necessity for Presymptomatic Prevention Strategies

Biological Psychiatry ◽

10.1016/j.biopsych.2013.11.019 ◽

2014 ◽

Vol 75 (7) ◽

pp. 553-557 ◽

Cited By ~ 6

Author(s):

Sam Gandy

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cell Types ◽

Prevention Strategies

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Update on Alzheimer's Disease Therapy and Prevention Strategies

Annual Review of Medicine ◽

10.1146/annurev-med-042915-103753 ◽

2017 ◽

Vol 68 (1) ◽

pp. 413-430 ◽

Cited By ~ 218

Author(s):

W. Vallen Graham ◽

Alessandra Bonito-Oliva ◽

Thomas P. Sakmar

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Prevention Strategies ◽

Disease Therapy

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A Systems Dynamic Approach to Alzheimer’s Disease Prevention

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.397 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Nasim S. Sabounchi

Keyword(s):

Risk Factors ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

System Dynamics ◽

Simulation Model ◽

Disease Incidence ◽

Prevention Strategies ◽

Key Factors ◽

Individual Level ◽

The Life Course

ABSTRACT ObjectivesAs estimated there are about 5.3 million who suffer from Alzheimer’s disease in United States. The incidence is increasing as the population is aging. Due to the increasing trend of Alzheimer’s disease, there is a lot of discussion on prevention efforts or slowing the incidence. Also, models that could predict individual risk of cognitive impairment are needed to assist in prevention efforts. In general dementia development has been associated with growth in various vascular, lifestyle and other risk factors. Epidemiological research provides evidence of some vascular, lifestyle and psychological risk factors that are modifiable and protective of disease incidence either independently or while interacting with other factors. However, as reported by National Institute of Aging, it is not yet clear whether health or lifestyle factors can prevent Alzheimer’s disease. The objective of this research project is to adopt a system dynamics modeling approach to study the interaction of several key factors including vascular, lifestyle and psychological aspects over the life course of individuals, to gain further understanding of Alzheimer’s disease incidence and evaluate prevention strategies. Both datasets of ‘Alzheimer's Disease Neuroimaging Initiative (ADNI)’ and ‘Health and Retirement Study (HRS)’ will be used for model development and validation. ApproachA system dynamics approach is an optimal choice for addressing the goal of this proposal because different key factors interact over time and make Alzheimer’s disease incidence a complex problem. Furthermore, system dynamics approaches focus on understanding the relationship between the structure of a system and the resulting dynamic behaviors generated through multiple interacting feedback loops. Such an approach could be invaluable in studying dynamic problems arising in complex health, social, economic, or ecological systems. ResultsFor the purpose of the proposal, the following stages are planned:1. Develop a system dynamics simulation model at individual level that predicts the Alzheimer’s disease incidence over the life course, and aggregates individual level models to predict population level trends 2. Calibrate the resulting simulation model based upon longitudinal data trends employed from Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Both cohorts with Alzheimer’s disease and control subjects from this database will be used to fine-tune the simulation model. ConclusionThe final validated model would be used to test different hypotheses and evaluate various strategies and/or their combinations to help evaluate the efficacy of prevention strategies on Alzheimer’s disease incidence and its growth.

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