title: Mortality and treatment costs have a great impact on the cost-effectiveness of disease modifying treatment in Alzheimer's disease--a simulation study.
abstract: BACKGROUND
  The societal costs of Alzheimer's Disease (AD) are enormous and pose a great challenge for the health and social care in any society. It is of vital importance to develop and identify cost effective treatment. The aim of the study was to present a hypothetical economic model of Disease Modifying Treatment (DMT) in AD.
  
  
  METHODS
  A 20 year Markov cohort model of DMT was constructed, based on Swedish care conditions. States and progression were defined according to the Mini Mental State Examination (MMSE). Epidemiological studies of incidence of dementia, prevalence and costs of Mild Cognitive Impairment (MCI) and AD as well as conversion studies of MCI and demographic statistics were used as inputs in the model.
  
  
  RESULTS
  Total costs were 113,797 million SEK for patients treated with DMT vs 88,562 million SEK for untreated patients. The corresponding gained QALYs were 529,945 and 450,307 respectively, giving an incremental cost effectiveness ratio of 293,002 SEK/QALY in the base option. Survival in the model was 8.72 years with DMT and 7.77 years for untreated. With an assumed Willingness to pay (WTP) of 600,000 SEK (about 86,200 US$ and 62,000 ) per gained QALY, the model indicated cost effectiveness with DMT. The sensitivity analysis implied no cost savings with DMT, but most options indicated cost effectiveness vs. the chosen WTP.
  
  
  CONCLUSIONS
  The main reasons for the higher costs with DMT were the costs of DMT itself and the prolonged survival with DMT. Even if costs increase with DMT, the model indicates cost effectiveness.
authors.affiliation: Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden. Anders.Skoldunger@ki.se
authors.forename: Anders
authors.initials: A
authors.lastname: Sköldunger
authors.forename: Kristina
authors.initials: K
authors.lastname: Johnell
authors.forename: Bengt
authors.initials: B
authors.lastname: Winblad
authors.forename: Anders
authors.initials: A
authors.lastname: Wimo
mesh_terms: D000544:Alzheimer Disease / Q000191:economics* / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D003072:Cognition Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D003362:Cost-Benefit Analysis / Q000191:economics*; D019468:Disease Management; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008390:Markov Chains; D008962:Models, Theoretical; D013548:Sweden / Q000453:epidemiology