Optimising Alzheimer's Disease Diagnosis and Treatment: Assessing Cost-Utility of Integrating Blood Biomarkers in Clinical Practice for Disease-Modifying Treatment

S. Aye*, R. Handels, B. Winblad, L. Jonsson

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background Recent developments in blood biomarkers (BBM) have shown promising results in diagnosing amyloid pathology in Alzheimer's Disease (AD). However, information on how these BBMs can best be used in clinical settings to optimise clinical decision-making and long-term health outcomes for individuals with AD is still lacking.Objectives We aim to assess the potential value of BBM in AD diagnosis within the context of disease-modifying treatment (DMT).Design We developed a decision analytic model to evaluate the long-term health outcomes using BBM in AD diagnosis. We compared standard of care (SOC) diagnosis workflow to the integration of BBM as a (1) referral decision tool in primary health center (PHC) and (2) triaging tool for invasive CSF examination in specialist memory clinic (MC). We combined a decision tree and a Markov model to simulate the patient's diagnostic journey, treatment decisions following diagnosis and long-term health outcomes. Input parameters for the model were identified from published literature and registry data analysis. We conducted a cost-utility analysis from the societal perspective using a one-year cycle length and a 30-year (lifetime) horizon.Measurements We reported the simulated outcomes in the percentage of correct diagnosis, costs (in 2022 Euros), quality-adjusted life year (QALY), and incremental cost-effectiveness ratios (ICER) associated with each diagnosis strategy.Results Compared to SOC, integrating BBM in PHC increased patient referrals by 8% and true positive AD diagnoses by 10.4%. The lifetime costs for individuals diagnosed with AD were euro 249,685 and euro250,287, and QALYs were 9.5 and 9.52 in SOC and PHC pathways, respectively. The cost increments were euro603, and QALYs gained were 0.01, resulting in an ICER of euro48,296. Using BBM in MC reduced the exposure to invasive CSF procedures and costs but also reduced true positive AD diagnoses and QALYs.Conclusions Using BBM at PHC to make referral decisions might increase initial diagnostic costs but can prevent high costs associated with disease progression, providing a cost-effective DMT is available, whereas using BBM in MC could reduce the initial evaluation cost but incur high costs associated with disease progression.
Original languageEnglish
Pages (from-to)928-942
Number of pages15
JournalJPAD-Journal of prevention of alzheimers disease
Volume11
Issue number4
Early online date1 Apr 2024
DOIs
Publication statusPublished - Aug 2024

Keywords

  • Cost-utility
  • blood biomarker
  • disease-modifying treatment
  • Alzheimer's disease
  • DEMENTIA
  • MORTALITY
  • DECLINE
  • IMPACT
  • MILD

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