Economic analysis of Alzheimer's disease in outpatients: impact of symptom severity

To assess the economic burden of Alzheimer's disease (AD), we carried out a cross-sectional prevalence cost-of-illness study in France. Fifty-one probable AD patients (NINCDS-ADRDA) actually treated in ambulatory care were recruited in two university outpatient centers. Demographic, clinical (including actual Mini-Mental State Examination scores), and economic data were collected by clinical investigators and trained interviewers. Total costs included actual expenditures such as direct medical costs and direct nonmedical costs, as well as indirect costs (loss of earnings due to loss of productivity). Cost valuation was based on the societal perspective using an opportunity costing approach. We found that indirect costs represented a significant portion of total costs (36%-40%). In terms of expenditures, patients and caregivers were found to bear the major part of AD total costs. We found a positive and significant correlation between disease severity and costs. Our findings support the hypothesis of a relationship between disease evolution and healthcare costs.

Methodological approaches to pharmaco-economics

Due to the increased need for cost-containment policies, most decision makers are facing the issue of the efficiency of health care strategies. In this context, economic evaluation becomes a major instrument. However, the credibility of economic data depends on a number of methodological steps: selection of strategy of economic evaluation (cost/effectiveness, cost/benefit, generation of economic hypotheses, study design (cross-sectional, prospective, naturalistic), data collection (data-base, physicians), data analysis (costing, statistics). In this respect, the conduct of proper economic evaluation relies on a combination of expertise in clinical epidemiology as well as in health economics.