An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom.

Background: Diagnosing and treating patients with Alzheimer's disease (AD) at an early stage should improve the quality of life of the patient and caregiver. In the United Kingdom, cost-effectiveness of early assessment of individuals presenting with subjective memory complaints and treating those with AD with donepezil was evaluated.

Methods: A discrete event simulation of AD progression and the effect of treatment interventions was developed.

Treating relapsing multiple sclerosis with subcutaneous versus intramuscular interferon-beta-1a: modelling the clinical and economic implications.

The EVIDENCE trial concluded that administering high-dose/high-frequency subcutaneous (SC) interferon-beta-1a (IFNb1a) was more effective in preventing relapses among patients with relapsing multiple sclerosis (MS) than low-dose weekly intramuscular (IM) IFNb1a after 64 weeks. This analysis utilized discrete-event simulation (DES) to model the potential longer-term clinical and economic implications of this trial. A DES predicting the course of relapsing MS and incorporating the effect of IFNb1a therapy was developed.

Iron chelation therapy: clinical effectiveness, economic burden and quality of life in patients with iron overload.

Introduction: This study of UK patients examines clinical, health-related quality of life (HRQOL) and economic outcomes associated with iron chelation therapy (ICT). Desferrioxamine (DFO) (Desferal; Novartis, Switzerland) and Deferiprone (Ferriprox; Apotex, Canada) are ICTs used to treat iron overload. DFO requires 8-to 12-hour infusions a minimum of five times per week.

Clinical and economic burden of infused iron chelation therapy in the United States.

Background: Patients requiring chronic blood transfusions are at risk for iron overload, which, if not treated by iron chelation therapy (ICT), can create serious organ damage and reduce life expectancy. Current ICT requires burdensome 8- to 12-hour infusions five to seven times per week.

Study Design And Methods: A naturalistic study of the burden of infused ICT was conducted in four US centers.

The time course of subsequent hospitalizations and associated costs in survivors of an ischemic stroke in Canada.

Background: Documentation of the hospitalizations rates following a stroke provides the inputs required for planning health services and to evaluate the economic efficiency of any new therapies.

Methods: Hospitalization rates by cause were examined using administrative data on 18,695 patients diagnosed with ischemic stroke (first or subsequent, excluding transient ischemic attack) in Saskatchewan, Canada between 1990 and 1995. Medical history was available retrospectively to January 1980 and follow-up was complete to March 2000.

Assessment of compliance with osteoporosis treatment and its consequences in a managed care population.

Objective: To evaluate non-compliance with osteoporosis medications as well as its implications for health and economic outcomes in actual practice.

Study Design: Data on demographics, prescription drug dispensing, physician services and hospitalizations were obtained from a US managed care database for women with osteoporosis who were dispensed an osteoporosis medication between 1997 and 2002.

Methods: Each subject's pattern of osteoporosis medication use was reconstructed using dispensing records.

Costs and medical care consequences associated with the diagnosis of peripheral arterial disease.

Background: Peripheral arterial disease (PAD) is increasingly recognised as an indicator of disseminated atherothrombosis, but its impact on use of healthcare resources is not well understood.

Objective: To provide a quantitative description of the resource utilisation and costs incurred following PAD.

Methods: Hospitalisations, physician visits and the corresponding direct medical costs were examined in 16,440 patients with a diagnosis of PAD (1985--1995) in Saskatchewan, Canada, and compared with 15,590 reference patients with a diagnosis of myocardial infarction (MI) [1990--1995].

The morbidity and mortality following a diagnosis of peripheral arterial disease: long-term follow-up of a large database.

Background: Awareness of the significance of peripheral arterial disease is increasing, but quantitative estimates of the ensuing burden and the impact of other risk factors remains limited. The objective of this study was to fill this need.

Methods: Morbidity and mortality were examined in 16,440 index patients diagnosed with peripheral arterial disease in Saskatchewan, Canada between 1985 and 1995.

Estimating survival for cost-effectiveness analyses: a case study in atherothrombosis.

Background: Economic evaluations typically require estimates of survival beyond the limited follow-up in clinical trials. The objective of this study was to demonstrate a data-driven approach to deriving these estimates.

Methods: To provide survival estimates for analyses of the CAPRIE trial, data were obtained from Saskatchewan on more than 50,000 patients like those in the trial: diagnosed with peripheral arterial disease (PAD), myocardial infarction, or ischemic stroke between 1985 and 1995; follow-up to December 31, 2000.

The impact of compliance with osteoporosis therapy on fracture rates in actual practice.

Background: Clinical trials have demonstrated that drug therapy can reduce osteoporosis-related fracture risk in women over 50 years of age. Noncompliance could considerably limit the effectiveness observed in actual practice, however. The objective of this study was therefore to estimate fracture risk in relation to compliance with osteoporosis medication in actual practice.

Modeling the efficiency of reaching a target intermediate end point: a case study in type 2 diabetes in the United States.

Objective: The objective of this study was to describe an approach to modeling the efficiency of an intervention by focusing on an established intermediate end point directly. A case study addresses the economic efficiency of obtaining dual glycemic control over time, according to initial choice of treatment.

Methods: From the perspective of a payer in the United States, instead of the usual approach of basing the model on projecting long-term diabetic complications from glycemic control, this model focuses directly on glycemic control.

Economic evaluation of galantamine in the treatment of mild to moderate Alzheimer's disease in the United States.

Background: Alzheimer's disease (AD) is estimated to affect up to 11% of those aged > or =65 years in the United States, and the number of patients with AD is predicted to increase over the next few decades as the population ages. The substantial social and economic burden associated with AD is well established, with the cost of management increasing as the disease progresses.

Objective: The aim of this study was to evaluate the economic impact of galantamine 16 and 24 mg/d relative to no pharmacologic treatment in the management of mild to moderate AD in the United States based on the concept of need for full-time care (FTC).

To what degree does cognitive impairment in Alzheimer's disease predict dependence of patients on caregivers?

Background: Patients with Alzheimer's disease experience a progressive loss of cognitive function, and the ability to independently perform activities of daily life. Sometimes a dependent stage is reached quite early in the disease, when caregivers decide that the patients can no longer be left alone safely. This is an important aspect of Alzheimer's for patients, their families, and also health care providers.