AUTHOR=Ren Yinan , Zhou Dachuang , Xing Qian , Gong Fangfang , Tang Wenxi 

TITLE=Economic evaluation of the screening for Alzheimer’s disease in China

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=Volume 14 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2022.968842

DOI=10.3389/fnagi.2022.968842

ISSN=1663-4365

ABSTRACT=Background: We evaluated the cost-effectiveness of the screening in mainland China for Alzheimer’s disease (AD) patients aged over 60.
Methods: Individuals in mainland China, received an initial screening by questionnaire on mental state, and those with scores deemed suspicious for AD were referred to diagnostic tests. A 9-state Markov model was developed to simulate the disease progression of a cohort of 100,000 subjects aging from 60 to 80. In addition, several scenarios were analyzed to assess the robustness under different screening frequency, starting age, the duration of drug effects, and the health status of subjects.
Results: The ICER of AD screening was 31422.48 USD per QALY (quality-adjusted life-year) compared with no screening. The number of deaths and severe AD cases who did not receive treatment averted by screening accounted for 0.11% and 0.01% of the total population, respectively, and the net monetary benefit was 46.15 USD per capita. Under the thresholds of one and three times the gross domestic product per capita, the probability of screening being cost-effective was approximately 12% and 55%, respectively. The ICER decreased to 21314.28USD per QALY when the drug effect was prolonged, and increased when the frequency of screening was increased, the starting age was postponed, and patients suffering from comorbidities were more. However, the number of severe AD cases and deaths declined when the screening frequency increased.
Conclusions: Screening for AD in individuals over 60 can reduce the numbers of severe AD cases and deaths and may be cost-effective, depending on factors such as screening frequency, starting age of screening, and duration of drug effects. Additionally, mild cognitive impairment is an important stage at which the burden of progression to AD may be reduced and the cost-effectiveness of screening may be improved.