title: Early cost-utility analysis of general and cerebrospinal fluid-specific Alzheimer's disease biomarkers for hypothetical disease-modifying treatment decision in mild cognitive impairment.
abstract: BACKGROUND
  The study aimed to determine the room for improvement of a perfect cerebrospinal fluid (CSF) biomarker and the societal incremental net monetary benefit of CSF in subjects with mild cognitive impairment (MCI) assuming a hypothetical disease-modifying Alzheimer's disease (AD) treatment.
  
  
  METHODS
  A decision model compared current practice to a perfect biomarker and to two strategies positioning CSF as add-on test when current practice concluded the presence or absence of AD.
  
  
  RESULTS
  The simulated MCI population was aged on average 68.3 and 49% had AD. The room for improvement by the perfect CSF test was 0.39 quality adjusted life years, €33,622 ($43,372) savings, 2.0 potential beneficial treatment years, and 1.3-year delay in dementia conversion.
  
  
  CONCLUSIONS
  The results indicated more potential benefit from a biomarker positioned to verify subjects who are not expected to have AD (i.e., to prevent undertreatment) rather than to verify subjects expected to have AD (prevent overtreatment). Sensitivity analyses explored different CSF positions.
authors.affiliation: Alzheimer Centre Limburg, department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Health Organization, Policy and Economics, School for Public Health and Primary Care, Maastricht, The Netherlands. Electronic address: ron.handels@maastrichtuniversity.nl.
authors.forename: Ron L H
authors.initials: RL
authors.lastname: Handels
authors.affiliation: Department of Health Organization, Policy and Economics, School for Public Health and Primary Care, Maastricht, The Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Manuela A
authors.initials: MA
authors.lastname: Joore
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: An
authors.initials: A
authors.lastname: Tran-Duy
authors.affiliation: Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Wimo
authors.affiliation: Alzheimer Centre Limburg, department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Claire A G
authors.initials: CA
authors.lastname: Wolfs
authors.affiliation: Alzheimer Centre Limburg, department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Frans R J
authors.initials: FR
authors.lastname: Verhey
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000134:cerebrospinal fluid / Q000150:complications / Q000191:economics; D003072:Cognition Disorders / Q000209:etiology* / Q000628:therapy*; D015331:Cohort Studies; D018672:Community Health Planning; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D016239:MEDLINE / Q000706:statistics & numerical data; D008297:Male; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care
keywords: Alzheimer's disease; Biomarker; Cerebrospinal fluid; Cost-utility; Decision analytic modeling; Economic evaluation; Hypothetical disease-modifying treatment; Mild cognitive impairment