Cost-effectiveness of cerebrospinal biomarkers for the diagnosis of Alzheimer’s disease

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dc.contributor.authorLee, Spencer A. W.
dc.contributor.authorSposato, Luciano A.
dc.contributor.authorHachinski, Vladimir
dc.contributor.authorCipriano, Lauren E.
dc.contributor.funderNatural Sciences and Engineering Research Council of Canadaen
dc.date.accessioned2017-04-10T11:10:05Z
dc.date.available2017-04-10T11:10:05Z
dc.date.issued2017-03-16
dc.description.abstractBackground: Accurate and timely diagnosis of Alzheimer’s disease (AD) is important for prompt initiation of treatment in patients with AD and to avoid inappropriate treatment of patients with false-positive diagnoses. Methods: Using a Markov model, we estimated the lifetime costs and quality-adjusted life-years (QALYs) of cerebrospinal fluid biomarker analysis in a cohort of patients referred to a neurologist or memory clinic with suspected AD who remained without a definitive diagnosis of AD or another condition after neuroimaging. Parametric values were estimated from previous health economic models and the medical literature. Extensive deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the results. Results: At a 12.7% pretest probability of AD, biomarker analysis after normal neuroimaging findings has an incremental cost-effectiveness ratio (ICER) of $11,032 per QALY gained. Results were sensitive to the pretest prevalence of AD, and the ICER increased to over $50,000 per QALY when the prevalence of AD fell below 9%. Results were also sensitive to patient age (biomarkers are less cost-effective in older cohorts), treatment uptake and adherence, biomarker test characteristics, and the degree to which patients with suspected AD who do not have AD benefit from AD treatment when they are falsely diagnosed. Conclusions: The cost-effectiveness of biomarker analysis depends critically on the prevalence of AD in the tested population. In general practice, where the prevalence of AD after clinical assessment and normal neuroimaging findings may be low, biomarker analysis is unlikely to be cost-effective at a willingness-to-pay threshold of $50,000 per QALY gained. However, when at least 1 in 11 patients has AD after normal neuroimaging findings, biomarker analysis is likely cost-effective. Specifically, for patients referred to memory clinics with memory impairment who do not present neuroimaging evidence of medial temporal lobe atrophy, pretest prevalence of AD may exceed 15%. Biomarker analysis is a potentially cost-saving diagnostic method and should be considered for adoption in high-prevalence centers.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationLee, S. A. W., Sposato, L. A., Hachinski, V. and Cipriano, L. E. (2017) ‘Cost-effectiveness of cerebrospinal biomarkers for the diagnosis of Alzheimer’s disease’, Alzheimer's Research and Therapy, 9 (18), pp. 1-14. doi:10.1186/s13195-017-0243-0en
dc.identifier.doi10.1186/s13195-017-0243-0
dc.identifier.endpage14en
dc.identifier.issn1758-9193
dc.identifier.issued18en
dc.identifier.journaltitleAlzheimer's Research and Therapyen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/3867
dc.identifier.volume9en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.rights© 2017, the Authors. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectAlzheimer’s diseaseen
dc.subjectCost-effectiveness analysisen
dc.subjectCerebrospinal fluid biomarkersen
dc.subjectNeuroimagingen
dc.titleCost-effectiveness of cerebrospinal biomarkers for the diagnosis of Alzheimer’s diseaseen
dc.typeArticle (peer-reviewed)en
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