scholarly journals The Economic Impact of New Therapeutic Interventions on Neuropsychiatric Inventory (NPI) Symptom Scores in Patients with Alzheimer Disease

2018 ◽  
Vol 8 (1) ◽  
pp. 158-173 ◽  
Author(s):  
Ali Tafazzoli ◽  
Anuraag Kansal ◽  
Peter Lockwood ◽  
Charles Petrie ◽  
Alexandra Barsdorf
Keyword(s):  
Alzheimer Disease ◽  
Neuropsychiatric Symptoms ◽  
Cost Effective ◽  
Therapeutic Interventions ◽  
Base Case ◽  
Model Assessment ◽  
Neuropsychiatric Inventory ◽  
Functional Relations ◽  
Symptom Scores ◽  
The Impact

Background/Aims: Few studies have modeled individual Neuropsychiatric Inventory (NPI) symptom scores for Alzheimer disease (AD) patients and assessed the value of therapeutic interventions that can potentially impact them. The main objective of this study was to evaluate the impact of new AD symptomatic treatments on relevant health economic outcomes via their potential effects on cognition and neuropsychiatric symptoms such as depression, irritability, anxiety, and sleep disorder. Methods: We enhanced the previously published AHEAD model (Assessment of Health Economics in Alzheimer’s Disease) by including new variables and functional relations to capture the NPI’s individual neuropsychiatric symptoms in addition to the total NPI score. This update allowed us to study the longitudinal effect of improvements in specific NPI subscale scores and the downstream impact on outcomes such as psychiatric medication use, survival, and institutional placement. Results: The model base-case results showed that a hypothetical treatment with symptomatic effects on anxiety, depression, and irritability NPI subscales was not cost-effective; however, the treatment’s cost-effectiveness was improved once a direct link between NPI subscales and mortality was explored or under relatively stronger treatment effects. Conclusion: Treatments that influence specific symptoms within the overall NPI have the potential to improve patient outcomes in a cost-effective way. This model is a useful tool for evaluating target product profiles of drugs with effect on NPI symptoms in early stages of development.

scholarly journals The impact of lockdown during SARS-CoV-2 outbreak on behavioral and psychological symptoms of dementia

2021 ◽  
Vol 42 (3) ◽  
pp. 825-833
Author(s):  
Arianna Manini ◽  
Michela Brambilla ◽  
Laura Maggiore ◽  
Simone Pomati ◽  
Leonardo Pantoni
Keyword(s):  
Logistic Regression ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Community Dwelling ◽  
Caregiver Distress ◽  
Neuropsychiatric Inventory ◽  
Logistic Regression Models ◽  
The Impact ◽  
Behavioral And Psychological Symptoms

Abstract Background During Covid-19 pandemic, the Italian government adopted restrictive limitations and declared a national lockdown on March 9, which lasted until May 4 and produced dramatic consequences on people’s lives. The aim of our study was to assess the impact of prolonged lockdown on behavioral and psychological symptoms of dementia (BPSD). Methods Between April 30 and June 8, 2020, we interviewed with a telephone-based questionnaire the caregivers of the community-dwelling patients with dementia who had their follow-up visit scheduled from March 9 to May 15 and canceled due to lockdown. Among the information collected, patients’ BPSDs were assessed by the Neuropsychiatric Inventory (NPI). Non-parametric tests to compare differences between NPI scores over time and logistic regression models to explore the impact of different factors on BPSD worsening were performed. Results A total of 109 visits were canceled and 94/109 caregivers completed the interview. Apathy, irritability, agitation and aggression, and depression were the most common neuropsychiatric symptoms experienced by patients both at baseline and during Covid-19 pandemic. Changes in total NPI and caregiver distress scores between baseline and during lockdown, although statistically significant, were overall modest. The logistic regression model failed to determine predictors of BPSD worsening during lockdown. Conclusion This is one of the first studies to investigate the presence of BPSD during SARS-CoV-2 outbreak and related nationwide lockdown, showing only slight, likely not clinically relevant, differences in BPSD burden, concerning mostly agitation and aggression, anxiety, apathy and indifference, and irritability.

scholarly journals Milk Powder Fortified with Potassium and Phytosterols to Decrease the Risk of Cardiovascular Events among the Adult Population in Malaysia: A Cost-Effectiveness Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 1235
Author(s):  
Anita E. Gandola ◽  
Livia Dainelli ◽  
Diane Zimmermann ◽  
Maznah Dahlui ◽  
Patrick Detzel
Keyword(s):  
Cost Effectiveness ◽  
Adult Population ◽  
Grey Literature ◽  
Milk Powder ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Discounted Cost ◽  
Life Years ◽  
The Impact

This study evaluated the cost-effectiveness of the consumption of a milk powder product fortified with potassium (+1050.28 mg/day) and phytosterols (+1200 mg/day) to lower systolic blood pressure and low-density lipoprotein cholesterol, respectively, and, therefore, the risk of myocardial infarction (MI) and stroke among the 35–75-year-old population in Malaysia. A Markov model was created against a do-nothing option, from a governmental perspective, and with a time horizon of 40 years. Different data sources, encompassing clinical studies, practice guidelines, grey literature, and statistical yearbooks, were used. Sensitivity analyses were performed to evaluate the impact of uncertainty on the base case estimates. With an incremental cost-effectiveness ratio equal to international dollars (int$) 22,518.03 per quality-adjusted life-years gained, the intervention can be classified as very cost-effective. If adopted nationwide, it would help prevent at least 13,400 MIs, 30,500 strokes, and more than 10,600 and 17,100 MI- and stroke-related deaths. The discounted cost savings generated for the health care system by those who consume the fortified milk powder would amount to int$8.1 per person, corresponding to 0.7% of the total yearly health expenditure per capita. Sensitivity analyses confirmed the robustness of the results. Together with other preventive interventions, the consumption of milk powder fortified with potassium and phytosterols represents a cost-effective strategy to attenuate the rapid increase in cardiovascular burden in Malaysia.

OP56 Rehabilitation Of Memory In Brain Injury: A Cost-Utility Analysis

2018 ◽  
Vol 34 (S1) ◽  
pp. 20-21
Author(s):  
Shaun Harris ◽  
Deborah Fitzsimmons ◽  
Roshan das Nair ◽  
Lucy Bradshaw
Keyword(s):  
Usual Care ◽  
Cost Effective ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Utility Analysis ◽  
Considerable Uncertainty ◽  
Memory Rehabilitation ◽  
The Impact

Introduction:People with traumatic brain injuries (TBIs) commonly report memory impairments which are persistent, debilitating, and reduce quality of life. As part of the Rehabilitation of Memory in Brain Injury trial, a cost-effectiveness analysis was undertaken to examine the comparative costs and effects of a group memory rehabilitation program for people with TBI.Methods:Individual-level cost and outcome data were collected. Patients were randomized to usual care (n=157) or usual care plus memory rehabilitation (n=171). The primary outcome for the economic analysis was the EuroQol-5D quality of life score at 12 months. A UK NHS costing perspective was used. Missing data was addressed by multiple imputation. One-way sensitivity analyses examined the impact of varying different parameters, and the impact of available cases, on base case findings whilst non-parametric bootstrapping examined joint uncertainty.Results:At 12 months, the intervention was GBP 26.89 (USD 35.76) (SE 249.15) cheaper than usual care; but this difference was statistically non-significant (p=0.914). At 12 months, a QALY loss of −0.007 was observed in the intervention group confidence interval (95% CI: −0.025–0.012) and a QALY gain seen in the usual care group 0.004 (95% CI: -0.017–0.025). This difference was not statistically significant (p=0.442). The base case analysis gave an ICER of GBP 2,445 (USD 3,252) reflecting that the intervention was less effective and less costly compared to usual care. Sensitivity analyses illustrated considerable uncertainty. When joint uncertainty was examined, the probability of the intervention being cost-effective at a willingness-to-pay threshold of GBP 20,000 per QALY gain was 29 percent and 24 percent at GBP 30,000.Conclusions:Our cost-utility analysis indicates that memory rehabilitation was cheaper but less effective than usual care but these findings must be interpreted in the light of small statistically non–significant differences and considerable uncertainty was evident. The ReMemBrIn intervention is unlikely to be considered cost-effective for people with TBI.

scholarly journals Measles CEA

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S64-S65
Author(s):  
Emily Hyle
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Economic Value ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
International Travel ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Cost Effectiveness Ratio ◽  
The Impact

Abstract Background Most measles importations are due to returning US travelers infected during international travel. We projected clinical outcomes and assessed cost-effectiveness of pretravel evaluation for measles immunity and MMR vaccination among eligible adult US international travelers. Methods We designed a decision tree to investigate pretravel evaluation compared with no evaluation from the societal perspective. Data from the Global TravEpiNet Consortium and published literature informed input parameters (Figure 1). Outcomes included measles cases averted per 10 million travelers, costs, and the incremental cost-effectiveness ratio (ICER, Δcosts/Δmeasles cases averted); we considered ICERs < $100,000/measles case averted to be cost-effective. We performed sensitivity analyses to assess the impact of varying the probability of exposure based on travel destination, and the percentage of travelers with pre-existing measles immunity. Results In the base case, departure after pretravel evaluation resulted in 16 measles importations and 46 transmissions per 10 million travelers and cost $132 million, vs without pretravel evaluation (26 importations and 87 transmissions per 10 million travelers, costing $22 million). Pretravel evaluation averted 51 measles cases per 10 million travelers with an ICER of $2.2 million per case averted. Results were most sensitive to the probability of measles exposure and the traveler’s pre-existing immunity (Figure 2). Pretravel evaluation was cost-effective for travelers to Asia if pre-existing measles immunity was <80%. Evaluation was always cost-effective for travelers to Africa when pre-existing immunity was less than 100% and became cost saving when the percentage of immune travelers was lower (<70%). Travelers who were more likely to be non-immune and were visiting destinations with higher probabilities of exposure were most likely to benefit from pretravel evaluation for measles immunity at excellent economic value. Conclusion As risk of measles exposure increases and likelihood of travelers’ pre-existing immunity decreases, it can be cost-effective or cost saving to assess US international travelers’ measles immunity status and vaccinate with MMR prior to departure. Disclosures All authors: No reported disclosures.

Acute Psychogeriatric Inpatient Treatment Improves Neuropsychiatric Symptoms but Impairs the Level of Functioning in Patients with Dementia

2015 ◽  
Vol 40 (5-6) ◽  
pp. 290-296 ◽  
Author(s):  
Hanna-Mari Alanen ◽  
Anneli Pitkänen ◽  
Kirsti Suontaka-Jamalainen ◽  
Olli Kampman ◽  
Esa Leinonen
Keyword(s):  
Mental State ◽  
Daily Living ◽  
Mini Mental State Examination ◽  
Neuropsychiatric Symptoms ◽  
Functional Decline ◽  
Neuropsychiatric Inventory ◽  
Behavioral Disturbances ◽  
Level Of Functioning ◽  
The Impact ◽  
State Examination

Aims: To explore the impact of hospitalization on neuropsychiatric symptoms (NPS) and the level of functioning in patients with dementia. Our aim was also to study the influence of psychotropic medications. Methods: Behavioral disturbances, cognition and functional status of 89 patients were assessed using the Neuropsychiatric Inventory (NPI), Mini-Mental State Examination, Barthel Index, and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCSADL). Results: The total NPI score decreased from 34.6 to 19.5 (p < 0.001), and ADL decreased from 32.2 to 21.7 (p < 0.001) during the hospital stay (mean of 44 days). For a change in ADL, only the effect of anxiolytics was significant (p = 0.045). For a change in NPI with antipsychotic and anxiolytic doses and Mini-Mental State Examination as covariates, no significant relationship was found. Conclusion: NPS improved significantly during hospitalization, but neither antipsychotic nor anxiolytic medication use explained this improvement. In patients using anxiolytics, the functional decline was substantial. These results do not support anxiolytic use in demented patients with NPS.

scholarly journals Coping strategies among caregivers of people with Alzheimer disease: a systematic review

2018 ◽  
Vol 40 (3) ◽  
pp. 258-268 ◽  
Author(s):  
Alexandre Magno Frota Monteiro ◽  
Raquel Luiza Santos ◽  
Nathália Kimura ◽  
Maria Alice Tourinho Baptista ◽  
Marcia Cristina Nascimento Dourado
Keyword(s):  
Alzheimer Disease ◽  
Coping Strategies ◽  
Neuropsychiatric Symptoms ◽  
Religion And Spirituality ◽  
Symptoms Of Depression ◽  
Thomson Scientific ◽  
Psychological Stressors ◽  
Family Behavior ◽  
Stress Burden ◽  
The Impact

Abstract Introduction Caregivers of people with Alzheimer disease (PwAD) report significant stress, burden and depression compared to caregivers of people with other dementias, especially when neuropsychiatric symptoms are prominent. Adequate coping strategies can modify the impact of stressful situations and increase the caregivers’ quality of life. Objective To systematically review the different coping strategies used by caregivers of PwAD to manage neuropsychiatric symptoms. Method We carried out electronic searches using MEDLINE (PubMed), SciELO, Web of Knowledge Cross Search (Thomson Scientific/ISI Web Services) and PsycINFO databases to select studies on coping in PwAD caregivers published from January 2005 to July 2017. The search terms were coping, caregivers, strategy, onset, adaptation, family, behavior, dementia and Alzheimer. The studies were organized in three categories: problem-focused, emotion-focused and dysfunctional coping strategies. Results We found 2,277 articles. After application of exclusion criteria and exclusion of redundant references, 24 articles were analyzed. Emotion-focused coping was the most commonly used strategy among PwAD caregivers. The use of this strategy associated with religion and spirituality may help reduce symptoms of depression and anxiety. Problem-focused coping strategies were mostly used with active coping interventions. Problem-solving coping may have buffered the impact of acute psychological stressors on procoagulant activity. Dysfunctional coping strategies were associated with increase of caregiver burden. Conclusion The evaluated studies showed that the use and development of coping strategies may have ameliorated the depressive symptoms, anxiety and burden of caregivers. However, longitudinal studies are still needed that clearly describe the type of coping strategy used in relation to the presented results.

scholarly journals Neuropsychiatric Effects on Decision-Making in Early Alzheimer Disease

2020 ◽  
Vol 33 (2) ◽  
pp. 68-72
Author(s):  
Oleg Yerstein ◽  
Andrew R. Carr ◽  
Elvira Jimenez ◽  
Mario F. Mendez
Keyword(s):  
Decision Making ◽  
Alzheimer Disease ◽  
Frontotemporal Dementia ◽  
Ultimatum Game ◽  
Neuropsychiatric Symptoms ◽  
The Other ◽  
Healthy Controls ◽  
Neuropsychiatric Inventory ◽  
Behavioral Variant Frontotemporal Dementia

Background: Neuropsychiatric symptoms can impact decision-making in patients with Alzheimer disease (AD). Methods: Using a simple decision-making task, a variant of the ultimatum game (UG) modified to control feelings of unfairness, this study investigated rejection responses among responders to unfair offers. The UG was administered to 11 patients with AD, 10 comparably demented patients with behavioral variant frontotemporal dementia (bvFTD), and 9 healthy controls (HC). The results were further compared with differences on the caregiver Neuropsychiatric Inventory (NPI). Results: Overall, patients with AD significantly rejected more total offers than did the patients with bvFTD and the HC ( P < .01). On the NPI, the only domain that was significantly worse among the patients with AD compared to the other groups was dysphoria/depression. Conclusions: These results suggest that early AD can be distinguished based on increased rejections of offers in decision-making, possibly consequent to a heightened sense of unfairness from dysphoria/depression.

Anosognosia and Its Relation to Psychiatric Symptoms in Early-Onset Alzheimer Disease

2017 ◽  
Vol 30 (3) ◽  
pp. 170-177 ◽  
Author(s):  
Bora Yoon ◽  
Yong S. Shim ◽  
Yun Jeong Hong ◽  
Seong Hye Choi ◽  
Hee Kyung Park ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Disease Severity ◽  
Early Onset ◽  
Sleep Disturbances ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Frontal Lobe Functions ◽  
The Individual

Background: We investigated differences in the prevalence of anosognosia and neuropsychiatric symptoms (NPSs) characteristics according to disease severity in patients with early-onset Alzheimer disease (EOAD). Methods: We recruited 616 patients with EOAD. We subdivided participants into 2 groups based on the presence or absence of anosognosia and then again by Clinical Dementia Rating (CDR) scale. We compared the differences in the Neuropsychiatric Inventory (NPI) scores according to anosognosia and disease severity. Results: The percentage of patients with anosognosia in each CDR group steadily increased as the CDR rating increased (CDR 0.5 8.6% vs CDR 1 13.6% vs CDR 2 26.2%). The NPI total score was significantly higher in patients with anosognosia in the CDR 0.5 and 1 groups; by contrast, it had no association in the CDR 2 group. Frontal lobe functions were associated with anosognosia only in the CDR 0.5 and 1 groups. After stratification by CDR, in the CDR 0.5 group, the prevalence of agitation ( P = .040) and appetite ( P = .013) was significantly higher in patients with anosognosia. In the CDR 1 group, patients with anosognosia had a significantly higher prevalence of delusions ( P = .032), hallucinations ( P = .048), and sleep disturbances ( P = .047). In the CDR 2 group, we found no statistical difference in the frequency of symptoms between patients with and without anosognosia. Conclusion: These results confirm that the prevalence of anosognosia as well as the individual NPS and cognitive functions associated with it differ according to EOAD severity.

scholarly journals Impact of Confinement on the Burden of Caregivers of Patients with the Behavioral Variant of Frontotemporal Dementia and Alzheimer Disease during the COVID-19 Crisis in France

2020 ◽  
pp. 127-134
Author(s):  
Claire Boutoleau-Bretonnière ◽  
Hélène Pouclet-Courtemanche ◽  
Aurélie Gillet ◽  
Amélie Bernard ◽  
Anne-Laure Deruet ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Alzheimer Disease ◽  
Frontotemporal Dementia ◽  
Caregiver Burden ◽  
Behavioral Change ◽  
Clinical Presentation ◽  
Neuropsychiatric Symptoms ◽  
Behavioral Changes ◽  
Behavioral Disturbances ◽  
The Impact

<b><i>Introduction:</i></b> The clinical presentation of the behavioral variant of frontotemporal dementia (bvFTD) differs from that of Alzheimer disease (AD), with major impairments in behavioral functions in bvFTD and cognitive impairment in AD. Both behavioral disturbances in bvFTD and cognitive impairment in AD contribute to caregiver burden. <b><i>Objective:</i></b> To investigate the impact of home confinement during the COVID-19 crisis on the burden of caregivers of bvFTD or AD patients. <b><i>Methods:</i></b> During the COVID-19 lockdown in France, neurologists and neuropsychologists from the Memory Center of Nantes Hospital conducted teleconsultations for 38 AD patients and 38 bvFTD patients as well as for their caregivers. During these consultations, caregivers were invited to rate the change in their burden during home confinement. They were also invited to rate behavioral or emotional changes in the patients during, compared with before, the confinement. <b><i>Results:</i></b> Twenty-two bvFTD caregivers and 14 AD caregivers experienced an increase in burden. For bvFTD caregivers, this increased burden occurred regardless of behavioral changes, while AD caregivers experienced an increased burden related to changes in patients’ neuropsychiatric symptoms. Among the whole cohort, 2 factors were associated with increased caregiver burden: behavioral change and bvFTD. <b><i>Conclusion:</i></b> The results demonstrate that during home confinement in the COVID-19 crisis, neuropsychiatric symptoms were the core factor that impacted caregiver burden in different ways depending on the disease.

scholarly journals Optimizing the use of the Men-ACWY conjugated vaccine to control the developing meningococcal W disease outbreak in the Netherlands, a rapid analysis

2018 ◽  
Author(s):  
Albert Jan van Hoek ◽  
Mirjam Knol ◽  
Hester de Melker ◽  
Jacco Wallinga
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Vaccination Campaign ◽  
Cost Effective ◽  
Reproductive Number ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Catch Up ◽  
The Impact

AbstractBackgroundThere is a developing outbreak of Neisseria meningitidis serotype W (MenW) in the Netherlands. In response, those aged 14 months and 14 years are vaccinated with the conjugated MenACWY vaccine. In the spring of 2018 we aimed to explore the impact of adding a one-off catch-up campaign targeting those aged 15-18 years on the transmission of MenW and the cost-effectiveness of such a campaign.MethodsWe estimated the growth rate of the MenW outbreak and quantified the impact of various targeted vaccination strategies on the reproductive number, and subsequently projected the future incidence with and without vaccination. Future cases were expressed in costs and QALYS and the incremental cost-effectiveness ratio was obtained.ResultsWe estimate a reproductive number of around 1.4 (95%CI 1.2-1.7) over the period February 2016-February 2018. Adding the catch-up campaign reduces the reproductive number five years earlier than without a catch-up campaign, to a level around 1.2. The vaccination campaign, including the catch-up, will prevent around 100 cases per year in our base case scenario. Given the projected impact and realistic assumptions on costs and QALYs, adding the catch-up can be considered cost-effective using a threshold of €20,000 per QALY.ConclusionAdding the catch-up campaign targeting those aged 15-18 brings the impact of vaccination on reducing transmission five years forward and directly prevents a high-incidence age group from carriage and disease. Such a campaign can be considered cost-effective. Our study did underpin the decision to introduce a catch-up campaign in spring 2019. Furthermore, our applied method can be of interest for anyone solving vaccine allocation questions in a developing outbreak.

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