OBJECTIVE: We aim to assess the potential value of BBM in AD diagnosis within the context of disease-modifying treatment (DMT).
METHODS: 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.
METHODS: 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 € 249,685 and €250,287, and QALYs were 9.5 and 9.52 in SOC and PHC pathways, respectively. The cost increments were €603, and QALYs gained were 0.01, resulting in an ICER of €48,296. 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.
目的:我们的目的是在疾病改善治疗(DMT)的背景下评估BBM在AD诊断中的潜在价值。
方法:我们开发了一个决策分析模型来评估在AD诊断中使用BBM的长期健康结果。我们将标准护理(SOC)诊断工作流程与BBM作为(1)初级健康中心(PHC)的转诊决策工具和(2)专科记忆诊所(MC)的侵入性CSF检查的分类工具进行了比较。我们结合决策树和马尔可夫模型来模拟病人的诊断过程,诊断和长期健康结果后的治疗决定。从已发表的文献和注册表数据分析中确定模型的输入参数。我们从社会的角度进行了成本效用分析,使用一年的周期长度和30年(寿命)期限。
方法:我们以正确诊断的百分比报告了模拟结果,成本(2022年欧元),质量调整寿命年(QALY),以及与每种诊断策略相关的增量成本效益比(ICER)。
结果:与SOC相比,在PHC中整合BBM使患者转诊率增加8%,AD诊断真阳性率增加10.4%.诊断为AD的个体的终生成本分别为249,685欧元和250,287欧元,SOC和PHC途径的QALYs分别为9.5和9.52。分别。费用增量为603欧元,QALY增加0.01欧元,导致ICER为48,296欧元。在MC中使用BBM减少了对侵入性CSF程序的暴露和成本,但也减少了真阳性AD诊断和QALY。
结论:在PHC使用BBM进行转诊决策可能会增加初始诊断成本,但可以防止与疾病进展相关的高成本,提供具有成本效益的DMT是可用的,而在MC中使用BBM可以降低初始评估成本,但会导致与疾病进展相关的高成本。