title: Disease progression and costs of care in Alzheimer's disease patients treated with donepezil: a longitudinal naturalistic cohort.
abstract: OBJECTIVE
  Improved data and methods are needed for modeling disease progression in Alzheimer's disease (AD) for economic evaluation of treatments. The aim is to estimate prediction models for long-term AD progression and subsequently economic outcomes.
  
  
  METHODS
  Three-year follow-up data on 435 patients treated with the cholinesterase inhibitor donepezil in clinical practise were analyzed. Regression models were estimated for long-term prediction of decline in cognitive function (ADAS-cog) and activities in daily living (ADL) ability, risk of institutionalization and costs of care.
  
  
  RESULTS
  The cognitive deterioration was estimated at between 1.6 and 4 ADAS-cog points per every 6 months, increasing with disease severity. Cognitive function was an important predictor of ADL-ability, which itself was the most important predictor of the risk of institutionalization and costs of care. Combining all models in a cross-validation process generated accurate predictions of costs of care at each 6 months follow-up.
  
  
  CONCLUSIONS
  The proposed methods for representing AD progression and economic outcomes can be used in micro-simulation models for the economic evaluation of new treatments.
authors.affiliation: i3 Innovus, Klarabergsviadukten 90 Hus D, 111 64, Stockholm, Sweden. anders.gustavsson@i3innovus.com
authors.forename: Anders
authors.initials: A
authors.lastname: Gustavsson
authors.forename: Linus
authors.initials: L
authors.lastname: Jönsson
authors.forename: Johan
authors.initials: J
authors.lastname: Parmler
authors.forename: Niels
authors.initials: N
authors.lastname: Andreasen
authors.forename: Carina
authors.initials: C
authors.lastname: Wattmo
authors.forename: Åsa K
authors.initials: ÅK
authors.lastname: Wallin
authors.forename: Lennart
authors.initials: L
authors.lastname: Minthon
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D003071:Cognition; D018450:Disease Progression; D000077265:Donepezil; D005260:Female; D017048:Health Care Costs; D006305:Health Status Indicators; D006801:Humans; D007189:Indans / Q000191:economics / Q000627:therapeutic use*; D007326:Institutionalization; D008137:Longitudinal Studies; D008297:Male; D018803:Models, Economic; D018697:Nootropic Agents / Q000191:economics* / Q000627:therapeutic use; D010880:Piperidines / Q000191:economics / Q000627:therapeutic use*; D011594:Psychometrics; D012044:Regression Analysis; D012720:Severity of Illness Index; D013548:Sweden
chemical_list: D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil