First International Pharmacoeconomic Conference on Alzheimer’s Disease
The First International Pharmacoeconomic Conference on Alzheimer’s Disease (AD) was held in Amsterdam in July 1998. The meeting was held under the auspices of the International Working Group for Harmonization of Dementia Drug Guidelines; bringing together academics, clinicians, purchasers, and representatives from industry. Presentations were given on the methodology of pharmacoeconomic studies in AD, particularly focusing on caregiver burden, quality of life (QOL), and resource utilization. Three economic models of AD were presented based on data from the United States, Canada, and the United Kingdom. In two studies, these data were then used to model the cost-effectiveness and effect on cost of treatment with donepezil. Both studies suggested a possible cost advantage for the use of donepezil, when compared with no placebo or treatment, particularly when donepezil is used appropriately in mild-to-moderate AD. These data need to be interpreted with care, as none of the cost or utility informations were collected during the clinical trials. Additional data from a 2-year clinical trial of selegiline and vitamin E suggest that cognitive measures may be poor predictors of economic outcome, which is better measured directly. Both economic models of donepezil rely on short-term cognitive data to predict long-term outcome, a method that may not be useful in predicting economic savings. The issues facing pharmacoeconomists, researchers, clinicians, and families in the future were addressed in a series of workshops using a method of strategic futuring. The workshops attempted to see 7 years into the future for a range of areas, including consumer and caregiver use of pharmacoeconomic data; early detection and prevention; Japanese perspectives; activities of daily life and what will be daily life activities; caregiver burden; QOL at the end of life; new uses for new information and communication technology in clinical research; and physicians’ use of pharmacoeconomic data. A range of exciting futures were predicted, although common themes that arose when considering barriers to achieving these futures included cost, education, political will, confidentiality, privacy, and ethics. The first conference was deemed to have been a success, having attracted more than 160 delegates and many distinguished speaker. A second conference is planned for the year 2000. Over the next 2 years, research needs to be broadened particularly in the methodological areas of resource utilization, QOL, and caregiver burden. Data from clinical trials with relevant economic and QOL outcomes will be needed by purchasers if drug treatments for dementia are to gain widespread use. It is also hoped that the models described at the meeting may become more freely available to politicians, purchasers, clinicians, and caregivers to help them make better decisions about treatment.
2nd International Pharmacoeconomic Conference on Alzheimer’s Disease
The 2nd International PharmacoEconomic Conference on Alzheimer’s Disease was held in Stockholm, Sweden, on April 4, 2000. The presentations focused on the role of cognition in pharmacoeconomic evaluations, the costs and consequences of behavioral disturbances, quality of life, disease progression models, and methods for valuing informal care. The results from individual studies will be published separately. Cognition has been used as the sole measure of disease severity in economic evaluations in dementia. However, behavioral disturbances are an important determinant of both cost and quality of life and should also be considered when appraising the effect of treatment. Quality-of-life assessment constitutes a single measure of the total impact of the disease, as well as a way of quantifying the benefits of treatment with antidementia drugs so that they can be compared with interventions in other disease areas. Measuring the quality of life of patients with dementia is associated with methodological difficulties related to the difficulties for some patients in completing usual assessment processes. Disease progression models may be helpful in extrapolating the results from clinical trials to longer time periods and more representative populations. Modeling is an unavoidable part of the economic evaluation of antidementia drugs, and efforts should be made to increase transparency and comparability among models. Informal care constitutes a large percentage of the total care for patients with dementia, and the valuation of these services has a large impact on the results of pharmacoeconomic evaluations. Difficulties lie in quantifying the time spent on caring for the elderly and in attaching the correct price to each unit of time. The contingent valuation method is an alternative way of valuing informal care that so far has not been used in the field of dementia.
3rd International Pharmacoeconomic Conference on Alzheimer’s Disease
The 3rd International PharmacoEconomic Conference on Alzheimer’s Disease was held in Stockholm, Sweden, on July 19-20, 2002, attracting 110 delegates and speakers. The focus of the presentations was on the following main topics: aspects on alternative study designs (observational studies, randomized controlled trials, modeling), costing issues (perspectives, valuing informal care, addressing co-morbidities), choice of outcome for economic evaluation (specific or generic quality of life scales, delay in disease progression), statistical considerations (methods for analysing stochastic cost-effectiveness data, missing data problems) and conjoint analysis of patient/caregiver preferences. Also several recent economic evaluations of treatments for mild, moderate and severe Alzheimer’s disease were presented.
4th International PharmacoEconomic Conference on Alzheimer’s Disease
The 4th International PharmacoEconomic Conference on Alzheimer’s Disease was held in Stockholm, Sweden, on September 25-26, 2005, attracting more than 100 delegates and speakers. The main topic of PEIV was “Approaches to Economic Assessment in Alzheimer’s Disease from Mild to Severe Dementia”
The focus of the presentations was on the following main topics: A review of the literature on the cost-effectiveness of treatment of dementia, based on the dementia report from The Swedish Council on Technology Assessment in Health Care, the use of registry data, The NICE guidelines, the AD 2000 paper, quality of life, the AD-CADIE study, nursing home care, outcome measures.
5th International PharmacoEconomic Conference on Alzheimer’s Disease
The 5th International Pharmaco-Economic Conference on Alzheimer’s Disease was held in Newark, New Jersey March 27-29, 2008. The attendees included researchers and key opinion leaders within the academia, pharmaceutical industry, patient organizations and regulatory bodies, collecting the worldwide leading expertise in Alzheimer research today. A summary of the presentations and conclusions from the discussions are presented in this publication. Pharmaco-economics need to play a leading role in developing and communicating evidence of the value of anti-dementia drugs, now and in the future. For the development of evidence, the challenges include transparency and standardization of costs of care assessment, improved diagnostics for identifying target patient groups, improved endpoints for assessing outcomes and improved models for assessing the long term consequences of competing treatment strategies. For the communication of evidence, the challenge lies in convincing decision makers to recognize the integrated burden of the disease, including its interaction with comorbidities and burden on caregivers, and to consider the consequences of competing treatment strategies from a societal perspective.
6th International PharmacoEconomic Conference on Alzheimer’s Disease
The 6th International PharmacoEconomic Conference on Alzheimer’s Disease took place at the Royal College of Physicians in London, UK, February 3-4, 2011. The following themes were discussed: epidemiology and global cost-of-illness, the role of trial-based economic evaluations, functional impairment and quality of life in early AD, willingness-to-pay for diagnostic testing, disease modeling and registry-based studies. A panel discussion reflected the views of regulators, payers and patient organizations on evidentiary requirements for approval, reimbursement and market access. Recent research findings were shared, eg on individuals’ preference for Alzheimer’s testing, the impact of cognitive decline on quality of life, and harmonized methods for the assessment of resource utilization and costs in dementia. The value of administrative and quality of care registers for research purposes was acknowledged with examples from Denmark, Sweden and the US. A collaborative approach was proposed to the development of health economic models in Alzheimer’s disease.
Linus Jönsson & Anders Gustavsson
7th International PharmacoEconomic Conference on Alzheimer’s Disease
The 7th International Pharmaco-Economic Conference on Alzheimer’s Disease (IPECAD) was held on November 19-20th 2015 in Boston, Massachusetts. The meeting gathered around 100 of the most knowledgeable researchers, policy makers, advocates and pharmaceutical industry representatives in the field, with the objective to share and discuss recent advancements relating to pharmacoeconomics in Alzheimer’s disease (AD). The focus of drug development is shifting towards disease modification in earlier stages of AD, which was a central theme across most of the conference talks. This shift comes with several development needs to further our understanding of the value of disease modifying drugs, including: better data on disease progression starting in pre-dementia stages of AD, more accurate screening and diagnostic tools for identifying patients, and improved outcome measures to detect subtle changes in early disease. The potential of population-based cohorts (eg the Mayo clinical study of aging) as well as other data sources was demonstrated as examples of pioneering research, which may be further enhanced by public-private partnerships. It was acknowledged that most of the potential value of early interventions will accrue in the long-term, beyond the duration of clinical trials or any follow-up data made available to decision makers. As a consequence, payers and policy makers need to rely on model simulations and deal with their inherent uncertainty when making decisions. The potential long-term impact of disease modification on patient mortality was presented as a clear example of how different assumptions can lead to totally opposing conclusions. Various policy instruments to deal with uncertainty were discussed, including collaborative efforts to agree on a reference modelling framework, and risk sharing schemes or other creative payment models to finance emerging treatments. In conclusion, the seventh IPECAD was a successful and highly appreciated meeting emphasizing the shared interest in and potential benefits of further collaboration in AD.
Linus Jönsson & Anders Gustavsson