title: Cost-effectiveness of the use of biomarkers in cerebrospinal fluid for Alzheimer's disease.
abstract: BACKGROUND
  The use of cerebrospinal fluid (CSF) biomarkers could facilitate early detection of Alzheimer's disease (AD) in patients with mild cognitive impairment (MCI) and the differential diagnosis between AD and non-AD dementias.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of the use of amyloid-β peptide (Aβ42), total tau and phosphorylated tau proteins in CSF to diagnose AD in MCI and dementia patients.
  
  
  METHODS
  An economic evaluation was performed by means of cost-effectiveness analysis comparing two AD diagnostic alternatives: the combined determination of Aβ42 proteins, total tau and phosphorylated tau in CSF as biomarkers of AD, and the standard clinical diagnosis based on the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINDS-ADRDA) criteria. A decision analytic model was developed to synthesize the identified evidence and to compare the costs and effectiveness associated with each diagnostic strategy. A probabilistic sensitivity analysis using 2nd order Monte Carlo simulations was performed. Subsequently, acceptability curves were calculated and ANCOVA models were applied to the results of the Monte Carlo simulations in order to identify the parameters that led greater variability in the model outcomes.
  
  
  RESULTS
  The use of CSF biomarkers as an early diagnostic strategy of AD in MCI patients is a dominant alternative (less costly and more effective strategy than standard clinical diagnostic criteria). In dementia patients, although there is a higher uncertainty, biomarkers in CSF seem a more cost-effective alternative than standard clinical diagnostic criteria.
  
  
  CONCLUSIONS
  Detecting AD in MCI patients by determining Aβ42, total tau and phosphorylated tau proteins biomarkers in CSF is a cost-effective diagnostic alternative. No conclusive results were obtained on dementia patients.
authors.affiliation: Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain Canary Islands Foundation for Health and Research (FUNCIS), Tenerife, Spain Centre for Biomedical Research of the Canary Islands (CIBICAN), La Laguna, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Valcárcel-Nazco
authors.affiliation: Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain Health Services Research on Chronic Patients Network (REDISSEC), Spain Centre for Biomedical Research of the Canary Islands (CIBICAN), La Laguna, Spain.
authors.forename: Lilisbeth
authors.initials: L
authors.lastname: Perestelo-Pérez
authors.affiliation: Alzheimer's disease and other cognitive disorders unit. IDIBAPS, Hospital Clinic, Barcelona, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Molinuevo
authors.affiliation: Health Services Research on Chronic Patients Network (REDISSEC), Spain Clinical Management Service, Alto Deba Hospital, Mondragon, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Mar
authors.affiliation: Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain Canary Islands Foundation for Health and Research (FUNCIS), Tenerife, Spain Health Services Research on Chronic Patients Network (REDISSEC), Spain Centre for Biomedical Research of the Canary Islands (CIBICAN), La Laguna, Spain.
authors.forename: Iván
authors.initials: I
authors.lastname: Castilla
authors.affiliation: Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain Health Services Research on Chronic Patients Network (REDISSEC), Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Serrano-Aguilar
mesh_terms: D000544:Alzheimer Disease / Q000134:cerebrospinal fluid* / Q000150:complications / Q000175:diagnosis* / Q000191:economics*; D016229:Amyloid beta-Peptides / Q000134:cerebrospinal fluid; D000704:Analysis of Variance; D015415:Biomarkers / Q000134:cerebrospinal fluid*; D060825:Cognitive Dysfunction / Q000209:etiology; D003362:Cost-Benefit Analysis; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D010446:Peptide Fragments / Q000134:cerebrospinal fluid; D012680:Sensitivity and Specificity; D016875:tau Proteins / Q000134:cerebrospinal fluid
chemical_list: D016229:Amyloid beta-Peptides; D015415:Biomarkers; D010446:Peptide Fragments; C075222:amyloid beta-protein (1-42); D016875:tau Proteins
keywords: Alzheimer's disease; amyloid-β; biomarkers; cost-effectiveness; diagnosis; phosphorylated tau; total tau