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Evaluación de las consecuencias socioeconómicas de la progresión de la enfermedad de Alzheimer en pacientes con demencia y deterioro cognitivo. Análisis exploratorio de la valoración de la eficacia de cinco medidas clínicas

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PharmacoEconomics Spanish Research Articles

Resumen

Objetivo

El objetivo principal de este análisis fue comparar el comportamiento de cinco medidas clínicas como posibles indicadores de las consecuencias socioeconómicas de la progresión del deterioro cognitivo y la demencia presentes en los pacientes con enfermedad de Alzheimer.

Métodos

El Mini-Mental State Examination (MMSE), el Cognitive Component Score (CCS), el Functional Component Score (FCS), el Behaviour Component Score (BCS) y la Escala de Dependencia (DS) fueron comparados respecto a su capacidad para explicar la variación en los resultados clínicos, los recursos económicos, la carga del cuidador (escala de Zarit) y la calidad de vida del cuidador (CdV, EQ-5D), utilizando un análisis estadístico univariante (correlación de Pearson) y multivariante (regresión lineal). Los datos sobre los pacientes y sus cuidadores se obtuvieron de varios centros sanitarios españoles.

Resultados

En este estudio se incluyeron datos de 394 pacientes de entre 50 y 93 años de edad con problemas de memoria, desde un deterioro cognitivo leve hasta demencia grave. También se analizaron los datos de sus cuidadores. Las tres escalas exploratorias y la DS estaban correlacionadas significativamente con los costes médicos, la carga del cuidador y su calidad de vida, mientras que el MMSE no lo estaba. La DS fue la única medida que mostró una correlación significativa con las tres medidas consideradas del cuidador (carga, calidad de vida y tiempo del cuidador no residente).

Conclusiones

Según los datos obtenidos, las tres escalas exploratorias y la DS fueron mejores predictores que el MMSE a la hora de predecir las consecuencias socioeconómicas del progreso de la enfermedad de Alzheimer. No es posible señalar cuál de estas cuatro medidas clínicas es la mejor.

Abstract

Objective

The primary objective of this analysis was to compare the performance of five alternative clinical measures as potential indicators of the socio-economic consequences of progression in patients with cognitive impairment and dementia.

Methods

The Mini-Mental State Examination (MMSE), 3 exploratory scales [Cognitive Component Score (CCS), Functional Component Score (FCS), Behaviour Component Score (BCS)], and the Dependence Scale (DS) were compared for their ability to explain variation in clinical outcomes, economic- and other utilized resources, caregiver burden (Zarit Scale) and caregiver quality of life (QoL; EQ-5D) using univariate (Pearson correlations) and multivariate (linear regression) analyses to assess their performance. Data on patients and their caregivers was obtained from multiple Spanish centres.

Results

Data on 394 patients aged 50 to 93 with memory impairments ranging from mild cognitive impairment to severe dementia and their caregivers were included in this study. The three exploratory scales and the DS were significantly correlated with socio-economic measures such as medical costs, caregiver burden and caregiver QoL, whilst MMSE was not. Most relationships held when other factors were controlled for. The DS was the only measure which significantly held a relationship with all three caregiver-assessed measures (i.e. caregiver burden, caregiver QoL and non-resident caregiver time).

Conclusions

In this exploratory analysis, the three exploratory measures and the DS were better predictors in modelling the socio-economic consequences of progression than the MMSE. Which of these four clinical measures is the best predictor of the socio-economic consequences could not be established.

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Financiación y conflicto de intereses

Este estudio ha sido financiado por Janssen Alzheimer Immunotherapy Research & Development, LLC y Pfizer Inc. a través de una ayuda a la investigación no condicionada.

Author information

Authors and Affiliations

  1. Departamento de Economía, Universitat de Barcelona, Diagonal, 690, 08034, Barcelona, España

    Josep Darbà

  2. BCN Health Economics & Outcomes Research, Barcelona, España

    Lisette Kaskens

  3. JANSSEN Alzheimer Immunotherapy, Dublín, Irlanda

    Loretto Lacey

  4. Hospital de la Santa Creu i Sant Pau, Barcelona, España

    Albert Lleo

  5. Adelphi Real World, Macclesfield, Cheshire, Reino Unido

    Peter Anderson

Authors
  1. Josep Darbà
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  2. Lisette Kaskens
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  3. Loretto Lacey
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  4. Albert Lleo
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  5. Peter Anderson
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Correspondence to Josep Darbà.

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Darbà, J., Kaskens, L., Lacey, L. et al. Evaluación de las consecuencias socioeconómicas de la progresión de la enfermedad de Alzheimer en pacientes con demencia y deterioro cognitivo. Análisis exploratorio de la valoración de la eficacia de cinco medidas clínicas. PharmacoEcon Span Res Artic 11, 39–50 (2014). https://doi.org/10.1007/s40277-013-0026-3

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