title: The cost of treatment of Alzheimer's disease in The Netherlands: a regression-based simulation model.
abstract: OBJECTIVE
  To examine the potential economic impact of treatment of Alzheimer's disease.
  
  
  METHODS
  Regression-based simulation estimation of the long term costs of Alzheimer's disease under a number of treatment scenarios. Data from an epidemiological study conducted in Rotterdam, The Netherlands, was used to simulate disease progression. Comparison of the costs and effectiveness experienced by the patients were used to measure the impact of treatment.
  
  
  METHODS
  2 theoretical cohorts of patients with Alzheimer's disease, one of which receives standard treatment, while the other receives a treatment which slows cognitive decline as measured by the Mini-Mental State Examination (MMSE).
  
  
  RESULTS
  Under one of the scenarios examined, the baseline cost of Alzheimer's disease was 97,866 euro (EUR; 1996 values) per patient over 10 years' follow-up; the cost was almost EUR100,000 under all scenarios. Life expectancy following onset was about 4.5 years and MMSE decline was approximately 2 points per year for a typical prevalent (existing) patient and almost twice as much for incident (newly diagnosed) patients (1.82 vs 3.42 points per year, respectively). Slowing the rate of cognitive decline results in a slightly increased life expectancy, with more time being spent at home and less in a nursing home. Total costs (excluding those of therapy) will decrease, but savings will be modest and may well be less than the cost of therapy. Under the same scenario, total savings were EUR1,571 per patient which corresponds to an annual break-even cost of just EUR453. Decisions regarding the initiation or termination of therapy will affect both the number of patients treated and the costs and potential savings of treatment.
  
  
  CONCLUSIONS
  The savings made in treating Alzheimer's disease will almost certainly be small in comparison with total costs and may well be offset by the cost of the treatment itself. Simulation models can be used to estimate the effect of therapy on the costs of care and can be useful tools in clinical decision-making and allocation of resources. These results show the need for further research into the costs and effects of treatment of Alzheimer's disease.
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands. mcdonnell@bmg.eur.nl
authors.forename: J
authors.initials: J
authors.lastname: McDonnell
authors.forename: W K
authors.initials: WK
authors.lastname: Redekop
authors.forename: N
authors.initials: N
authors.lastname: van der Roer
authors.forename: E
authors.initials: E
authors.lastname: Goes
authors.forename: A
authors.initials: A
authors.lastname: Ruitenberg
authors.forename: J J
authors.initials: JJ
authors.lastname: Busschbach
authors.forename: M M
authors.initials: MM
authors.lastname: Breteler
authors.forename: F F
authors.initials: FF
authors.lastname: Rutten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000145:classification / Q000188:drug therapy / Q000191:economics*; D017281:Cost of Illness; D004522:Educational Status; D005260:Female; D006707:Homes for the Aged / Q000191:economics; D006801:Humans; D008297:Male; D009426:Netherlands; D009735:Nursing Homes / Q000191:economics; D012720:Severity of Illness Index