Cost-Utility of Using Alzheimer’s Disease Biomarkers in Cerebrospinal Fluid to Predict Progression from Mild Cognitive Impairment to Dementia

Article type: Research Article

Authors: Handels, Ron L.H.^{a; b; *} | Wimo, Anders^b | Dodel, Richard^c | Kramberger, Milica G.^{b; d} | Visser, Pieter Jelle^{a; e} | Molinuevo, José Luis^{f; g} | Verhey, Frans R.J.^a | Winblad, Bengt^b

Affiliations: [a] Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands | [b] Department of Neurobiology, Care Science and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institute, Huddinge, Sweden | [c] Department of NeuroGeriatrics, University Duisburg-Essen, Essen, Germany | [d] Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia | [e] Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands | [f] Alzheimer Disease and Other Cognitive Unit, Hospital Clinic, IDIBAPS, Barcelona, Spain | [g] Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain

Correspondence: [*] Correspondence to: Ron Handels, Alzheimer Centre Limburg, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 43 3881036; E-mail: ron.handels@maastrichtuniversity.nl.

Abstract: Background:Diagnostic research criteria for Alzheimer’s disease support the use of biomarkers in the cerebrospinal fluid (CSF) to improve the accuracy of the prognosis regarding progression to dementia for people with mild cognitive impairment (MCI). Objective:The aim of this study was to estimate the potential incremental cost-effectiveness ratio of adding CSF biomarker testing to the standard diagnostic workup to determine the prognosis for patients with MCI. Methods:In an early technology assessment, a mathematical simulation model was built, using available evidence on added prognostic value as well as expert opinion to estimate the incremental costs and quality-adjusted life years (QALYs) of 20,000 virtual MCI patients with (intervention strategy) and without (control strategy) relying on CSF, from a health-care sector perspective and with a 5-year time horizon. Results:Adding the CSF test improved the accuracy of prognosis by 11%. This resulted in an average QALY gain of 0.046 and € 432 additional costs per patient, representing an incremental cost-effectiveness ratio of € 9,416. Conclusion:The results show the potential of CSF biomarkers in current practice from a health-economics perspective. This result was, however, marked by a high degree of uncertainty, and empirical research is required into the impact of a prognosis on worrying, false-positive/negative prognosis, and stigmatization.

Keywords: Alzheimer’s disease, cerebrospinal fluid, cost-utility, economic evaluation, mild cognitive impairment, prognosis, risk

DOI: 10.3233/JAD-170324

Journal: Journal of Alzheimer's Disease, vol. 60, no. 4, pp. 1477-1487, 2017