BMC Med Inform Decis Mak - Modeling screening, prevention, and delaying of Alzheimer's disease: an early-stage decision analytic model.

Tópicos

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Resumo

CKGROUND: Alzheimer's Disease (AD) affects a growing proportion of the population each year. Novel therapies on the horizon may slow the progress of AD symptoms and avoid cases altogether. Initiating treatment for the underlying pathology of AD would ideally be based on biomarker screening tools identifying pre-symptomatic individuals. Early-stage modeling provides estimates of potential outcomes and informs policy development.METHODS: A time-to-event (TTE) simulation provided estimates of screening asymptomatic patients in the general population age > or =55 and treatment impact on the number of patients reaching AD. Patients were followed from AD screen until all-cause death. Baseline sensitivity and specificity were 0.87 and 0.78, with treatment on positive screen. Treatment slowed progression by 50%. Events were scheduled using literature-based age-dependent incidences of AD and death.RESULTS: The base case results indicated increased AD free years (AD-FYs) through delays in onset and a reduction of 20 AD cases per 1000 screened individuals. Patients completely avoiding AD accounted for 61% of the incremental AD-FYs gained. Total years of treatment per 1000 screened patients was 2,611. The number-needed-to-screen was 51 and the number-needed-to-treat was 12 to avoid one case of AD. One-way sensitivity analysis indicated that duration of screening sensitivity and rescreen interval impact AD-FYs the most. A two-way sensitivity analysis found that for a test with an extended duration of sensitivity (15 years) the number of AD cases avoided was 6,000-7,000 cases for a test with higher sensitivity and specificity (0.90,0.90).CONCLUSIONS: This study yielded valuable parameter range estimates at an early stage in the study of screening for AD. Analysis identified duration of screening sensitivity as a key variable that may be unavailable from clinical trials.

Resumo Limpo

ckground alzheim diseas ad affect grow proport popul year novel therapi horizon may slow progress ad symptom avoid case altogeth initi treatment under patholog ad ideal base biomark screen tool identifi presymptomat individu earlystag model provid estim potenti outcom inform polici developmentmethod timetoev tte simul provid estim screen asymptomat patient general popul age treatment impact number patient reach ad patient follow ad screen allcaus death baselin sensit specif treatment posit screen treatment slow progress event schedul use literaturebas agedepend incid ad deathresult base case result indic increas ad free year adfi delay onset reduct ad case per screen individu patient complet avoid ad account increment adfi gain total year treatment per screen patient numberneededtoscreen numberneededtotreat avoid one case ad oneway sensit analysi indic durat screen sensit rescreen interv impact adfi twoway sensit analysi found test extend durat sensit year number ad case avoid case test higher sensit specif conclus studi yield valuabl paramet rang estim earli stage studi screen ad analysi identifi durat screen sensit key variabl may unavail clinic trial

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