title: Modeling test and treatment strategies for presymptomatic Alzheimer disease.
abstract: OBJECTIVE
  In this study, we developed a model of presymptomatic treatment of Alzheimer disease (AD) after a screening diagnostic evaluation and explored the circumstances required for an AD prevention treatment to produce aggregate net population benefit.
  
  
  METHODS
  Monte Carlo simulation methods were used to estimate outcomes in a simulated population derived from data on AD incidence and mortality. A wide variety of treatment parameters were explored. Net population benefit was estimated in aggregated QALYs. Sensitivity analyses were performed by individually varying the primary parameters.
  
  
  RESULTS
  In the base-case scenario, treatment effects were uniformly positive, and net benefits increased with increasing age at screening. A highly efficacious treatment (i.e. relative risk 0.6) modeled in the base-case is estimated to save 20 QALYs per 1000 patients screened and 221 QALYs per 1000 patients treated.
  
  
  CONCLUSIONS
  Highly efficacious presymptomatic screen and treat strategies for AD are likely to produce substantial aggregate population benefits that are likely greater than the benefits of aspirin in primary prevention of moderate risk cardiovascular disease (28 QALYS per 1000 patients treated), even in the context of an imperfect treatment delivery environment.
authors.affiliation: Dept. of Neurology, University of Michigan, Ann Arbor, Michigan, United States of America; Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, United States of America; Center for Clinical Management Research, VAAAHS, Ann Arbor, Michigan, United States of America.
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
authors.affiliation: Dept. of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America; Center for Clinical Management Research, VAAAHS, Ann Arbor, Michigan, United States of America; Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, United States of America; Dept. of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America; Center for Clinical Management Research, VAAAHS, Ann Arbor, Michigan, United States of America.
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
authors.affiliation: Dept. of Neurology, University of Michigan, Ann Arbor, Michigan, United States of America; Geriatric Research, Education, and Clinical Center, and Neurology Service, VAAAHS, Ann Arbor, Michigan, United States of America; Michigan Alzheimer Disease Center, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Albin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000517:prevention & control*; D058070:Asymptomatic Diseases; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity