Aim 2: Compare the cost-effectiveness and affordability of the identified ADRD interventions for the population at-large and by race and ethnicity.
- Cost-effectiveness
- We will use the results obtained from estimating treatment effects (aim 1) to conduct the cost-effectiveness analyses. The first step in conducting the cost-effectiveness analyses is identifying competing interventions.
- We will conduct an incremental cost-effectiveness analysis of all interventions, for the population at-large and by race/ethnicity (between and within analysis), against usual care. The between race/ethnicity cost-effectiveness analysis will indicate interventions that are more or less effective by population due to variation in potential access to interventions. We will also conduct an incremental cost-effectiveness analysis of competing interventions by intervention category. Interventions that manage both functional decline and behaviors will be compared against both intervention types.
- We will conduct our cost-effectiveness evaluation (population at-large and by race/ethnicity) from societal (cost of intervention implementation plus costs to Medicare/Medicaid/families), health system (cost of intervention implementation plus costs to Medicare and Medicaid), and family (the cost of purchasing the intervention and family costs) perspectives.
- We will adopt a willingness-to-pay threshold of $109,000/QALY
- Because we are evaluating cost-effectiveness separately based on the person with ADRD’s QALYs and caregiver’s QALYs, there can be scenarios where an intervention is not cost-effective from the person with ADRD perspective but is cost effective from the caregiver’s perspective or vice versa. This is not a threat to our findings as ADRD affects the person with the disease and their family.
- Affordability of nondrug ADRD interventions
- Cost-effectiveness indicates if an intervention offers value; however, it does not indicate if the intervention is affordable. Using the results from the cost-effectiveness analyses we will conduct a budget impact evaluation to determine the affordability of each intervention from health care system and family perspectives.
- Our evaluation of affordability from the health care system perspective will account for the number of current ADRD cases (overall ~5 million cases) and future ADRD incident cases (overall ~476,000/yr) over the next 10 years.
- We will use US Census data and published incidence rates to determine the number of ADRD cases by race/ethnicity.
- When evaluating the budget impact from a family perspective we will reference the net cost of purchasing interventions against Median household income. Median household income of older adults with similar characteristics to those with ADRD, stratified by race/ethnicity, will be obtained from the Health and Retirement Study.
- Optimal combination of nondrug ADRD interventions
- Multiple nondrug ADRD interventions can be used over the course of the disease, but the optimal combination of interventions is unknown. We will simulate, overall and by race/ethnicity, treatment strategies that employ multiple nondrug interventions over the disease trajectory.
- Sensitivity analyses and parameter uncertainty
- As with Aim 1, we will conduct sensitivity analyses of all results under the varying structural assumptions and in one-way and two-way sensitivity analyses. We will evaluate uncertainty of all results with a PSA.