The worldwide costs of dementia in 2019

Introduction: Dementia is a leading cause of death and disability globally. Estimating total societal costs demonstrates the wide impact of dementia and its main direct and indirect economic components. Methods: We constructed a global cost model for dementia, presenting costs as cumulated global and regional costs. Results: In 2019, the annual global societal costs of dementia were estimated at US $1313.4 billion for 55.2 million people with dementia, corresponding to US$23,796 per person with dementia. Of the total, US $213.2 billion (16$448.7 billion (34%) direct social sector costs (including long-term care), and US $651.4 billion (50$1313.4 in 2019. Sixty-one percent of people with dementia live in low-and middle-income countries, whereas 74% of the costs occur in high-income countries. The impact of informal care accounts for about 50% of the global costs. The development of a long-term care infrastructure is a great challenge for low-and middle-income countries. There is a great need for more cost studies, particularly in low- and middle-income countries. Discussions of a framework for global cost comparisons are needed

Cost-Effectiveness of Surveillance Programs of Carriers of Pathogenic Mutations in the TP53-Gene in Sweden

Introduction: Pathogenic mutations in the TP53-gene is present in about 50% of all somatic cancers. The TP53 gene’s function is to stop cancer cells from dividing, thus protect us from cancer. When this gene is not functioning properly, carriers face 70-100% risk of developing cancer in their lifetime. Early diagnosis of cancer improves survival and currently individuals with pathogenic hereditary mutations in this gene are entitled to an extensive surveillance program to increase early detection of cancer. A new study, the Swedish TP53 study (SWEP53), is investigating a surveillance program offering whole-body magnetic resonance imaging (WBMRI) of confirmed carriers. It is not known if the potential health effects of such surveillance programs justify the additional costs. The objective of this thesis was to determine whether any of the surveillance programs are cost-effective in Sweden. Methods: A novel decision analytic model was developed using a health care perspective covering the lifetime of carriers of mutations in TP53. Nine different cancers were modelled. All cancers carry a cost. an impact on health-related quality of life and survival. Three separate scenarios were investigated; no surveillance, surveillance by current standard of care and surveillance using WBMRI as proposed in the SWEP53-study. The total costs and total quality adjusted life years (QALY) of each scenario were used to calculate incremental cost-effectiveness ratios for the current standard of care and the SWEP53-protocol. Results: Surveillance of both male and female carriers of pathogenic mutations in TP53 carries an incremental cost-effectiveness ratio of 748 194 SEK. Surveillance using is WBMRI carries a cost of more than seven million SEK. If the annual probability of diagnosis is ca 40-50 percentage points higher than in the standard of care this may change to a level similar to SOC in the current analysis. The greatest uncertainty of the results lay in the estimation of the impact on survival from cancer diagnosis and annual probability of diagnosis. Conclusion: The incremental cost per QALY of the current surveillance program is likely acceptable in Sweden given the rarity and severity of being a carrier of a hereditary pathogenic mutation in TP53. Surveillance using WBMRI carries an incremental cost per QALY that is much higher than what is traditionally acceptable in Sweden. The clinical benefit of surveillance using WBMRI in relation to current surveillance is unclear and more data is needed. This analysis is made under great uncertainty but shows that when analyzing hereditary mutations, it is imperative to consider the whole spectrum of attributed disease as this greatly impacts the cost-effectiveness of e.g. surveillance. These estimates may be uncertain but as of today this is the only and the best estimate available

The Oxford Democrat : Vol 19. No. 37 - October 02, 1868

https://digitalmaine.com/oxford_democrat/1039/thumbnail.jp

The worldwide costs of dementia in 2019

International audienceIntroduction: Dementia is a leading cause of death and disability globally. Estimating total societal costs demonstrates the wide impact of dementia and its main direct and indirect economic components. Methods: We constructed a global cost model for dementia, presenting costs as cumulated global and regional costs. Results: In 2019, the annual global societal costs of dementia were estimated at US $1313.4 billion for 55.2 million people with dementia, corresponding to US$23,796 per person with dementia. Of the total, US $213.2 billion (16$448.7 billion (34%) direct social sector costs (including long-term care), and US $651.4 billion (50%) costs of informal care. Discussion: The huge costs of dementia worldwide place enormous strains on care systems and families alike. Although most people with dementia live in low-and middle-income countries, highest total and per-person costs are seen in high-income countries

The worldwide costs of dementia in 2019

Introduction: Dementia is a leading cause of death and disability globally. Estimating total societal costs demonstrates the wide impact of dementia and its main direct and indirect economic components.Methods: We constructed a global cost model for dementia, presenting costs as cumulated global and regional costs.Results: In 2019, the annual global societal costs of dementia were estimated at US $1313.4 billion for 55.2 million people with dementia, corresponding to US$23,796 per person with dementia. Of the total, US $213.2 billion (16$448.7 billion (34%) direct social sector costs (including long-term care), and US $651.4 billion (50%) costs of informal care.Discussion: The huge costs of dementia worldwide place enormous strains on care systems and families alike. Although most people with dementia live in low- and middle-income countries, highest total and per-person costs are seen in high-income countries

Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis The RINOMAX Randomized Clinical Trial

IMPORTANCE Rituximab is a third-line option for refractory generalized myasthenia gravis (MG) based on empirical evidence, but its effect in new-onset disease is unknown. OBJECTIVE To investigate the efficacy and safety of rituximab compared with placebo as an add-on to standard of care for MG. DESIGN, SETTING, AND PARTICIPANTS This randomized, double-blind, placebo-controlled study took place throughout 48 weeks at 7 regional clinics in Sweden. Key inclusion criteria were age older than 18 years, onset of generalized symptoms within 12 months or less, and a Quantitative Myasthenia Gravis (QMG) score of 6 or more. Patients were screened from October 20, 2016, to March 2, 2020. Key exclusion criteria included pure ocular MG, suspected thymoma, previous thymectomy, and prior noncorticosteroid immunosuppressants or high doses of corticosteroids. INTERVENTIONS Participants were randomized 1:1 without stratification to a single intravenous infusion of 500 mg of rituximab or matching placebo. MAIN OUTCOMES AND MEASURES Minimal disease manifestations at 16 weeks defined as a QMG score of 4 or less with prednisolone, 10 mg or less daily, and no rescue treatment. RESULTS Of 87 potentially eligible patients, 25 were randomized to rituximab (mean [SD] age, 67.4 [13.4] years; 7 [28%] female) and 22 to placebo (mean [SD] age, 58 [18.6] years; 7 [32%] female). Compared with placebo, a greater proportion with rituximab met the primary end point; 71% (17 of 24) in the rituximab group vs 29% (6 of 21) in the placebo group (Fisher exact test P = .007; probability ratio, 2.48 [95% CI, 1.20-5.11]). Secondary end points, comparing changes in Myasthenia Gravis Activities of Daily Living and Myasthenia Gravis Quality of Life at 16 weeks with QMG at 24 weeks did not differ between groups with censoring for rescue treatment (per-protocol analysis) but were in favor of active treatment when rescue treatment was taken into account by worst rank imputation (post hoc analysis). Rescue treatments were also more frequent in the placebo arm (rituximab: 1 [4%]; placebo, 8 [36%]). One patient in the placebo arm had a myocardial infarction with cardiac arrest and 1 patient in the active arm experienced a fatal cardiac event. CONCLUSIONS AND RELEVANCE A single dose of 500 mg of rituximab was associated with greater probability of minimal MG manifestations and reduced need of rescue medications compared with placebo. Further studies are needed to address long-term benefit-risk balance with this treatment.Funding Agencies|Swedish Medical Research Council [2015-00887, 2020-02700]</p