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A Wimo

Publications and source records attributed to A Wimo.

At least 19 recordsLinked to original sources
PubMed2006

3-year study of donepezil therapy in Alzheimer's disease: effects of early and continuous therapy.

Delays in the diagnosis of Alzheimer's disease, and, therefore, delays in treatment, may have a detrimental effect on a patient's long-term well-being. This study assessed the effects of postponing donepezil treatment for 1 year by comparing patients treated continuously for 3 years with those who received placebo for 1 year followed by open-label donepezil for 2 years. Patients (n = 286) with possible or probable Alzheimer's disease (according to DSM-IV, NINCDS-ADRDA, and Mini-Mental State Examination criteria; see text) were randomized to receive donepezil (5 mg/day for 4 weeks, 10 mg/day thereafter) or placebo (delayed-start group) for 1 year. Of the 192 completers, 157 began a 2-year, open-label phase of donepezil treatment. Outcome measures were the Gottfries-Bråne-Steen scale, the Mini-Mental State Examination, the Global Deterioration Scale, the Progressive Deterioration Scale, the Neuropsychiatric Inventory, and safety (adverse events). Mixed regression analysis was used to compare changes between the groups over 3 years on the efficacy measures. There was a trend for patients receiving continuous therapy to have less global deterioration (Gottfries-Bråne-Steen scale) than those who had delayed treatment (p = 0.056). Small but statistically significant differences between the groups were observed for the secondary measures of cognitive function (Mini-Mental State Examination; p = 0.004) and cognitive and functional abilities (Global Deterioration Scale; p = 0.0231) in favor of continuous donepezil therapy. Over 90% of the patients in both cohorts experienced one treatment-emergent adverse event; most were considered mild or moderate. In conclusion, patients in whom the start of treatment is delayed may demonstrate slightly reduced benefits as compared with those seen in patients starting donepezil therapy early in the course of Alzheimer's disease. These data support the long-term efficacy and safety of donepezil.

Aged↗
PubMed2006

An estimate of the worldwide prevalence and direct costs of dementia in 2003.

Dementia disorders are today considered to be a major driver of costs in health care and social systems and worrying estimates of future dementia prevalence have been presented. It is of great interest for policy makers to have an estimate of dementia disorders' contribution to global social and health care costs, particularly in light of the demographic prognoses. The worldwide costs of dementia were estimated from prevalence figures for different regions, and cost-of-illness studies from key countries using a model based on the relationship between direct costs of care per demented and the gross domestic product per capita in each country. The worldwide direct costs for dementia in 2003 are estimated at 156 billion USD in the main scenario based on a worldwide prevalence of 27.7 million demented persons (sensitivity analysis: 129-159 billion USD). Ninety-two percent of the costs are found in the advanced economies with 38% of the prevalence. Although there are several sources of uncertainty, it is obvious that the worldwide costs are substantial and the expected increase in elderly people in the developing countries presents a great challenge.

Cost of Illness↗
PubMed2005

The amount of informal and formal care among non-demented and demented elderly persons-results from a Swedish population-based study.

BACKGROUND: Developed countries are experiencing a dramatic increase in the proportion of elderly persons, as well as a progressive aging of the elderly population itself. Knowledge regarding the amount of formal and informal care and its interaction at population-based level is limited. OBJECTIVES: To describe the amount of formal and informal care for non-demented and demented persons living at home in a population-based sample. METHODS: The population consisted of all inhabitants, 75 + years, living in a rural community (n = 740). They were clinically examined by physicians and interviewed by nurses. Dementia severity was measured according to Washington University Clinical Dementia Rating Scale (CDR). Informal and formal care was examined with the RUD (Resource Utilization in Dementia) instrument. RESULTS: The amount of informal care was much greater than formal care and also greater among demented than non-demented. There was a relationship between the severity of the cognitive decline and the amount of informal care while this pattern was weaker regarding formal care. Tobit regression analyses showed a clear association between the number of hours of informal and formal care and cognitive decline although this pattern was much stronger for informal than formal care. CONCLUSIONS: Informal care substitutes rather than compliments formal care and highlights the importance of future studies in order to truly estimate the amount of informal and formal care and the interaction between them. This knowledge will be of importance when planning the use of limited resources, and when supporting informal carers in their effort to care for their intimates.

Activities of Daily Living↗
PubMed2004

Economic aspects on drug therapy of dementia.

The great number of people suffering from dementia present a great challenge for the health care and social support systems. In a situation where resources are scarce, health economical aspects of dementia care are of great importance in order to identify cost-effective care. However, the literature in this field is limited. There are also aspects where there methodological development is necessary (e.g. informal care, quality of life, long term effects). In the absence of prospective long term data, it is necessary to use pharmacoeconomical models. It is also important to have population based data for the description of how resources and costs are allocated between the different care sectors. Current data show that there is a strong relationship between cognitive functioning and costs. The number of pharmacoeconomical evaluations of drugs influencing on the symptomatology of dementia is low. Available data show that there is support for a view that treatment is cost-neutral or perhaps cost saving which in combination with positive effects in terms of efficacy may indicate cost-effectiveness.

Caregivers↗
PubMed2003

Cost analysis of incisional hernia repair by suture or mesh.

The objective was to make a cost analysis of incisional hernia repair by suture repair or prosthetic mesh repair. The study included 44 patients who underwent hernia repair between 1991 and 2000. The rate of recurrent incisional hernia after more than 1 year with associated costs was registered. In 1996, the technique of incisional hernia repair was changed from suture repair to mesh repair. With a mesh repair, zero out of 19 patients presented with a recurrence at follow-up, and with suture repair, five out of 13 had a recurrence (P<0.01). The duration of anaesthetic and operation was longer, but stay in the surgical ward, and sick leave was shorter for patients with a mesh repair than for those with a suture repair. For working patients, costs in the operating theatre were 4,095 Swedish kronor (SEK) higher with a mesh repair, and the costs for surgical ward, sick leave, and examination were 10,129 SEK lower than with a suture repair. Thus, with a mesh repair, the total costs were 6,034 SEK lower than with a suture repair. For retired patients, the total costs with a mesh repair were 1,898 SEK lower than with a suture repair. We conclude that in this setting, mesh repair of incisional hernias produced lower costs than suture repair.

Adult↗
PubMed2001

[Can the costs of future needs of health and social services for the elderly be calculated?].

As a consequence of the increasing number of elderly people, the proportion of people of working age (20-65) vs. the oldest-old (80+) will decrease considerably. Today, the total annual cost for the care of the elderly (health care and social services) in Sweden is about SEK 110 billion (about 6% of the GNP). The costs of health care are better correlated with the number of remaining years of life than with number of years from birth. The cost of health care during the last year in life is higher for the oldest-old than for the young-old. Informal care of demented persons is about 4-5 times more extensive than formal care. There is a strong correlation between GNP per citizen and resources spent on health care.

Aged↗
PubMed2001

A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD.

OBJECTIVE: To evaluate the long-term clinical efficacy and safety of donepezil versus placebo over 1 year in patients with mild to moderate AD. METHODS: Patients (n = 286; mean age, 72.5 years) with possible or probable AD from five Northern European countries were randomized to receive either donepezil (n = 142; 5 mg/day for 28 days, followed by 10 mg/day) or placebo (n = 144) for 1 year. RESULTS: The study was completed by 66.9% of the donepezil- and 67.4% of the placebo-treated patients. The benefit of donepezil over placebo was demonstrated by the Gottfries-Bråne-Steen (a global assessment for rating dementia symptoms) total score at weeks 24, 36, and 52 (p < 0.05) and at the study end point (week 52, last observation carried forward; p = 0.054). Advantages of donepezil over placebo were also observed in cognition and activities of daily living (ADL) assessed by the Mini-Mental State Examination at weeks 24, 36, and 52, and the end point (p < 0.02) and by the Progressive Deterioration Scale at week 52 and the end point (p < 0.05). Adverse events (AE) were recorded for 81.7% of donepezil- and 75.7% of placebo-treated patients, with 7% of donepezil- and 6.3% of placebo-treated patients discontinuing because of AE. Treatment response to donepezil was not predicted by APOE genotype or sex in this population. CONCLUSION: As the first 1-year, multinational, double-blinded, placebo-controlled study of a cholinesterase inhibitor in AD, these data support donepezil as a well tolerated and effective long-term treatment for patients with AD, with benefits over placebo on global assessment, cognition, and ADL.

Aged↗
PubMed2001

The impact of psychosocial 'markers' on the outcome of rehabilitation.

PURPOSE: The aim of this study was to identify substantial psychosocial events--'psychosocial markers' (PMs) in the clients files and to correlate the PMs to the outcome of the rehabilitation, in order to find out whether this information had any impact on the outcome of vocational rehabilitation (VR). METHOD: Three-hundred and seventy-two individuals were included, being an object of a VR measure during 1993-1994. All were impaired by either disc hernia back pain syndrome or other diseases of the loco-motor system. The PM was defined as any psychosocial loaded information of the person's life situation, not immediately related to the original set of medical problems. RESULTS: Twenty-seven PMs were identified among men and 36 for women. Alcohol related problems dominated for men and private life related problems for women. Only approximately 25% of the PM concerned work related matters. After 3 years the OR (odds ratio) for full disability pension was 2.6 (n.s.) for men with the PM and 4.3 (p < 0.05) for women. The outcome was independent of background factors such as unemployment, blue-collar work and low education. CONCLUSIONS: The PM was found to be an important and independent factor to impact the outcome of rehabilitation in women.

Back Pain↗
PubMed2000

[Troubled times in care of the elderly. Increasing number of the "oldest old" and demented, shortage of general practitioners and lack of clarity with regards to locating resources].

The media image of general breakdown in care of the elderly, replete with portrayals of malpractice and maltreatment, is analyzed in the light of changes in demographics, care resources and care delivery systems during the past decades. A substantial increase in the number of people aged 80 years or more, increasing numbers of elderly persons with dementia, deinstitutionalization of health care, together with the present economic crisis, place a considerable burden on the care system, as illustrated by an increased nursing load, a decrease in the number of elderly persons receiving home services, and a concentration of support to the most impaired. The author calls attention to the need for refined methods for describing care delivery systems, longitudinal population based studies, and a national hospital plan. Primary health care, already pushed to the limit by dwindling resources and job vacancies, is hard put to shoulder the burden of responsibility for the elderly.

Aged↗
PubMed2000

Cost minimisation analysis of change in closure technique of midline incisions.

OBJECTIVES: To make a cost minimisation analysis of incisional hernia repair at a county hospital and extrapolate the results nationally. SETTING: County hospital, Sweden. SUBJECTS: 861 patients who underwent midline laparotomy between August 1989 and November 1992. INTERVENTIONS: In April 1991 surgeons were urged to change their suture technique towards wound closure with a suture length: wound length ratio of at least 4. MAIN OUTCOME MEASURES: Rate of incisional hernia at 12 months and the number of hernia repairs required with associated costs. RESULTS: The average cost of one hernia repair was SEK 42643. After the intervention the risk of requiring a hernia repair was reduced by 0.016 for each patient operated on through a midline incision. The cost was reduced by SEK 686 and the cost of an operation 5 minutes longer was SEK 570, so the intervention generated savings of SEK 116 for each patient operated on. A similar reduction on a national level would yield annual savings of SEK 2107140, which may be regarded as the annual opportunity cost of an inadequate surgical technique in Sweden. CONCLUSIONS: An alteration to the suture technique that reduces the rate of incisional hernia and the number of hernia repairs required is cost effective and generates savings.

Cost Savings↗
PubMed2000

Outcome measures in Alzheimer's disease: do they go far enough?

As the interest in Alzheimer's disease (AD) and its treatment has grown, so has the sophistication of clinical trials of potential drug therapies. In particular, interest has focused on outcomes used to assess the severity of the illness and the effectiveness of treatment. This paper reviews the assessments that are used frequently in trials of AD therapy and describes further measures that may be of value in determining effective treatments for the disease. The review concludes that it is important that evaluation of drug effects on AD is not confined solely to the assessment of cognitive function. To gain a true overview of the impact of AD on patients, carers and society, areas such as activities of daily living, caregiver burden, quality of life, behavioural symptoms and resource utilization need to be comprehensively determined.

Alzheimer Disease↗
PubMed1999

The social consequences for families with Alzheimer's disease patients: potential impact of new drug treatment.

The social consequences of Alzheimer's disease are highlighted in this review with regard to impact on family situation, a changing treatment context caused by demographic changes, reorganization of long-term care, a financial crisis in the public health systems and the introduction of antidementia drugs. In the early phase of dementia there may be significant consequences for the patients and the family members which are largely unrecognized by the healthcare system. As the disease progresses, the impact on caregivers in terms of physical and emotional burden, financial and employment status may be enormous. The current care provision in Sweden, the UK and The Netherlands is described. Innovative care alternatives and strategies may improve the situation. The introduction of antidementia drugs such as the acetylcholine esterase inhibitors may also contribute to improved circumstances for patients and caregivers. There is still a great need for further research in this field.

Activities of Daily Living↗
PubMed1999

The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer's disease: a Markov model.

This study compared the cost-effectiveness of donepezil, a new cholinesterase inhibitor indicated for the treatment of mild-to-moderate probable Alzheimer's disease (AD), with no treatment. A Markov state transition model was employed to simulate treatment costs based on Swedish epidemiologic data. The Markov states used in the model were defined according to cognitive function, as assessed by the Mini-Mental State Examination. Data on costs and baseline transition probabilities were taken from the Kungsholmen Project, an observational, population-based study of persons aged >75 years in Sweden. Data on the treatment effect were taken from a clinical trial comparing donepezil to placebo over 24 weeks and were applied to the baseline transition probabilities to assess the effect of treating the clinical manifestations of AD in Swedish patients. Also, a within-trial analysis was performed for comparison, using transition probabilities taken from the clinical study. Both models were run for 5 years in half-year cycles, and both demonstrated various degrees of cost savings and improved effectiveness, as measured by increased time in nonsevere disease states. Thus donepezil had superior cost-effectiveness compared with no treatment.

Aged↗
PubMed1999

Costs of Mini Mental State Examination-related cognitive impairment.

OBJECTIVE: To investigate the relationship between cognitive impairment, measured with the Mini Mental State Examination (MMSE), and the cost of care. DESIGN: The study uses data from the Kungsholmen project, a population-based study in Sweden in which people 75 years and older were observed over time. The initial study population (n = 1810) was divided into 4 health states based on the MMSE. A Markov model was constructed from the transition probabilities between different states between the first and second phases of the study. The expected cost of cognitive impairment for a period of 10 years was estimated for the cohort of patients studied. MAIN OUTCOME MEASURES AND RESULTS: There was a strong correlation between cognitive impairment in terms of the MMSE and the annual cost of care. A multivariate statistical analysis showed that a decrease in the MMSE by 1 point was associated with an increase in the cost of care of 15,000 Swedish kronor (SEK) [$US2000; 1995 values]. CONCLUSIONS: The results show that large savings are possible if the decline in cognitive functioning can be prevented. The model developed can be used to estimate the impact on cost of care of treatments which reduce the cognitive decline in patients with Alzheimer's disease.

Aged↗
PubMed1999

Assessing the societal impact of acetylcholinesterase inhibitor therapies.

The symptomatology of Alzheimer disease (AD), its longevity, and associated cost make it an extremely challenging disease for individuals, their families, health care, and social support systems. Moreover, the expanding aging population worldwide means that strategies to contain costs are an urgent priority. As the largest component of the direct costs of AD is due to the cost of institutionalization, cost-containment strategies have focused on ways to maintain the AD patient in the community for as long as possible. Disease severity is a strong predictor of institutionalization, and patients' cognitive function (in the form of their Mini-Mental State Examination score) is frequently used as a prognostication of their living environment, and thus the overall cost of their care. Strategies to maintain patients at home are directed at either the patient's symptoms or the caregiver's ability to cope with those symptoms and the responsibilities of caregiving. Examples of strategies directed at the caregiver include education and support programs. Drug treatments, notably acetylcholinesterase inhibitors, present the best option for improving patient function, thereby preserving patient autonomy. A number of preliminary studies, whose results are summarized here, have demonstrated that the use of the acetylcholinesterase inhibitors tacrine, metrifonate and donepezil, and the glial cell modulator, propentofylline, results in reductions in the overall costs of care. Most health economic studies have focused only on comparison of the costs associated with paying for administering a treatment and the savings produced by postponed institutionalization. However, there is a growing realization that some measures of the quality of life or well-being of both patient and caregiver should also be incorporated. Thus, the health economics of dementia is an extremely complex area of study that is rapidly growing, due to the likelihood that cost-effectiveness will form the basis for future reimbursement decisions.

Alzheimer Disease↗
PubMed1998

First International Pharmacoeconomic Conference on Alzheimer's Disease: report and summary.

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 (http://dementia.ion.ucl.ac.uk/harmon), 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 information 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 methodf 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.

Aged↗