Informal Care Time and Cost in a Large Clinical Trial Sample of Patients with Mild to Moderate Alzheimer's Disease: Determinants and Level of Change Observed.

Introduction: We evaluate the association between caregiver (informal) time/cost and illness severity from two recently completed clinical trials of an investigational drug for Alzheimer's disease (AD).

Methods: Changes from baseline caregiver time were calculated and treatment effects analyzed using a restricted maximum likelihood-based mixed model for repeated measures. Four separate models were then estimated to examine the association between caregiver time costs and the clinical endpoints measured during the trials, including cognition (MMSE), function (DAD), behavior (NPI), global disability (CDR) and dependence (DS).

Psychometric properties of the Dependence Scale in large randomized clinical trials of patients with mild and moderate Alzheimer's disease.

Objective: The need for assistance from others is a hallmark concern in Alzheimer's disease (AD). The psychometric properties of the Dependence Scale (DS) for measuring treatment benefit were investigated in large randomized clinical trials of patients with mild to moderate AD.

Methods: Reliability, validity, and responsiveness of the DS were examined.

Dependence as a unifying construct in defining Alzheimer's disease severity.

This article reviews measures of Alzheimer's disease (AD) progression in relation to patient dependence and offers a unifying conceptual framework for dependence in AD. Clinicians typically characterize AD by symptomatic impairments in three domains: cognition, function, and behavior. From a patient's perspective, changes in these domains, individually and in concert, ultimately lead to increased dependence and loss of autonomy.

Burden of Alzheimer's disease and association with negative health outcomes.

Objective: To examine the association of Alzheimer's disease (AD) with common chronic conditions, acute care events, and risk of hospitalization.

Study Design: Retrospective matched cohort analysis.

Methods: Community-dwelling subjects with a diagnosis of and/or medication for AD were matched to subjects without AD based on age, sex, and geographic region.

Prevalence and impact of dementia-related functional limitations in the United States, 2001 to 2005.

These analyses examined the relationship between dementia and comorbid conditions with respect to degree of functional impairment and emotional impact. Analyses were conducted using National Health Interview Survey (2001 through 2005) data from a subset of individuals aged > or =60 years with activity limitations attributed to dementia, senility, or Alzheimer disease compared with those whose limitations were attributed to other conditions. The mean number of limited activities was 6.

Patient dependence and longitudinal changes in costs of care in Alzheimer's disease.

Background/aims: To examine the incremental effect of patients' dependence on others, on cost of medical and nonmedical care, and on informal caregiving hours over time.

Methods: Data are obtained from 172 patients from the Predictors Study, a large, multicenter cohort of patients with probable Alzheimer disease (AD) followed annually for 4 years in 3 University-based AD centers in the USA. Enrollment required a modified Mini-Mental State Examination score >or=30.

Older Americans' risk-benefit preferences for modifying the course of Alzheimer disease.

Alzheimer disease (AD) is a progressive, ultimately fatal neurodegenerative illness affecting millions of patients, families, and caregivers. Effective disease-modifying therapies for AD are desperately needed, but none currently exist on the market. Thus, accelerating the discovery, development, and approval of new disease-modifying drugs for AD is a high priority for individuals, physicians, and medical decision makers.

The effects of patient function and dependence on costs of care in Alzheimer's disease.

Objectives: To estimate incremental effects of patients' dependence and function on costs of care during the early stages of Alzheimer's disease (AD) and to compare strengths of their relationships with different cost components.

Design: Multicenter, cross-sectional, observational study.

Setting: Three university hospitals in the United States.

Risk of recurrent emergency department visits or hospitalizations in children with asthma receiving nebulized budesonide inhalation suspension compared with other asthma medications.

Objective: To examine whether nebulized budesonide inhalation suspension treatment reduces asthma-related emergency department visit/hospitalization recurrence risk in children compared with other asthma medications, particularly non-nebulized inhaled corticosteroids.

Research Design And Methods: Longitudinal, retrospective claims analysis of data from a managed care organization database in the United States (July 1, 2000-June 30, 2002). Participants were children aged < or = 8 years with an asthma diagnosis and asthma-related emergency department visit or hospitalization (index event).

Inhaled corticosteroids vs leukotriene receptor antagonists: health care costs across varying asthma severities.

Background: The burden of asthma is substantial, and the overall cost of its management is growing.

Objective: To compare asthma-related charges and resource utilization across disease severity levels in the year after initial asthma treatment with any inhaled corticosteroid (ICS) or leukotriene receptor antagonist (LTRA).

Methods: This was a longitudinal, retrospective cohort study of claims data from managed care plans in the United States.

Inhaled corticosteroid use and outcomes in pregnancy.

Background: Current asthma management guidelines recommend aggressive asthma treatment for women who are pregnant.

Objective: To examine asthma medication use and asthma-related health care use before and during pregnancy.

Methods: Women aged 15 to 45 years with a pregnancy claim (index event) and an asthma claim (diagnosis or asthma medication prescription) were identified from a database of US managed care organizations (PharMetrics Patient-Centric Database).

Patient preferences for sensory attributes of intranasal corticosteroids and willingness to adhere to prescribed therapy for allergic rhinitis: a conjoint analysis.

Background: Sensory attributes of intranasal corticosteroid (INS) products vary.

Objective: To evaluate patient preferences for INS sensory attributes and the degree to which attributes influence patients' willingness to adhere to therapy.

Methods: We conducted a cross-sectional study with 120 individuals across 4 US allergy/immunology clinics.

Cost efficiency of intranasal corticosteroid prescribing patterns in the management of allergic rhinitis.

Background: Effective treatment of seasonal or perennial allergic rhinitis often requires use of topical intranasal corticosteroids (INSs). Despite differences in recommended starting dosages, the 4 leading INSs by market share are packaged in bottles containing 120 metered-dose sprays.

Objective: To determine the relative prescribed dosages of the leading INSs and compare economic differences resulting from these prescribing behaviors.

Evaluating the efficiency of treatment in the allergic rhinitis market.

Background: In the present era of increasing health care expenditures, economic comparisons of therapeutic products play an important role in ensuring that limited health care resources are used appropriately.

Objective: To provide a model for the comparative analysis of alternative treatments, in terms of both cost and efficacy, in allergic rhinitis that will provide decision makers in a managed care environment an additional tool to help maximize health care benefit per dollar spent. We also review current treatments in the allergic rhinitis market and their impact on cost, availability, and utilization.