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Using Cerebrospinal Fluid Biomarker Testing to Target Treatment to Patients with Mild Cognitive Impairment: A Cost-Effectiveness Analysis

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  • Tzeyu L. Michaud

    (University of Nebraska Medical Center
    University of Nebraska Medical Center)

  • Robert L. Kane

    (University of Minnesota)

  • J. Riley McCarten

    (Minneapolis Veterans Affairs Medical Center
    University of Minnesota Medical School)

  • Joseph E. Gaugler

    (University of Minnesota)

  • John A. Nyman

    (University of Minnesota)

  • Karen M. Kuntz

    (University of Minnesota)

Abstract

Objective Cerebrospinal fluid (CSF) biomarkers are shown to facilitate a risk identification of patients with mild cognitive impairment (MCI) into different risk levels of progression to Alzheimer’s disease (AD). Knowing a patient’s risk level provides an opportunity for earlier interventions, which could result in potential greater benefits. We assessed the cost effectiveness of the use of CSF biomarkers in MCI patients where the treatment decision was based on patients’ risk level. Methods We developed a state-transition model to project lifetime quality-adjusted life-years (QALYs) and costs for a cohort of 65-year-old MCI patients from a US societal perspective. We compared four test-and-treat strategies where the decision to treat was based on a patient’s risk level (low, intermediate, high) of progressing to AD with two strategies without testing, one where no patients were treated during the MCI phase and in the other all patients were treated. We performed deterministic and probabilistic sensitivity analyses to evaluate parameter uncertainty. Results Testing and treating low-risk MCI patients was the most cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of US$37,700 per QALY. Our results were most sensitive to the level of treatment effectiveness for patients with mild AD and for MCI patients. Moreover, the ICERs for this strategy at the 2.5th and 97.5th percentiles were US$18,900 and US$50,100 per QALY, respectively. Conclusion Based on the best available evidence regarding the treatment effectiveness for MCI, this study suggests the potential value of performing CSF biomarker testing for early targeted treatments among MCI patients with a narrow range for the ICER.

Suggested Citation

  • Tzeyu L. Michaud & Robert L. Kane & J. Riley McCarten & Joseph E. Gaugler & John A. Nyman & Karen M. Kuntz, 2018. "Using Cerebrospinal Fluid Biomarker Testing to Target Treatment to Patients with Mild Cognitive Impairment: A Cost-Effectiveness Analysis," PharmacoEconomics - Open, Springer, vol. 2(3), pages 309-323, September.
    • Handle: RePEc:spr:pharmo:v:2:y:2018:i:3:d:10.1007_s41669-017-0054-z
    DOI: 10.1007/s41669-017-0054-z
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    1. L. M. Peña-Longobardo & B. Rodríguez-Sánchez & J. Oliva-Moreno & I. Aranda-Reneo & J. López-Bastida, 2019. "How relevant are social costs in economic evaluations? The case of Alzheimer’s disease," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(8), pages 1207-1236, November.
    2. Zehra Önen Dumlu & Serpil Sayın & İbrahim Hakan Gürvit, 2023. "Screening for preclinical Alzheimer’s disease: Deriving optimal policies using a partially observable Markov model," Health Care Management Science, Springer, vol. 26(1), pages 1-20, March.

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