Happich, M.

Johnson, F.R.

Mühlbacher, A.C.

Yang, J.C.

Elsevier - Publisher Connector 

A402  VA L U E  I N  H E A LT H  1 7  ( 2 0 1 4 )  A 3 2 3 – A 6 8 6  
PND67
ImPact of caregIvINg for PatIeNts wIth alzheImer’s DIsease aND 
DemeNtIa oN PsychIatrIc aND clINIcal comorbIDItIes IN brazIl
Goren A.1, Novick D.2, Barros B.R.3, Laks J.4, Dueñas H.5, Kahle-Wrobleski K.6
1Kantar Health, New York, NY, USA, 2Eli Lilly and Company, Windlesham, UK, 3Eli Lilly do Brasil 
Ltda, São Paulo, Brazil, 4Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 5Eli Lilly de 
Mexico, Mexico City, Mexico, 6Eli Lilly and Company, Indianapolis, IN, USA
Objectives: Patients with dementia due to Alzheimer’s disease (AD) are often cared 
for by family members who experience physical, psychological, social, and financial 
burdens associated with provision of care. This study quantifies the impact of caregiv-
ing in Brazil and helps identify characteristics associated with caregiving. MethOds: 
Data were analyzed from the 2012 National Health and Wellness Survey (NHWS) 
in Brazil (n = 12,000), an Internet-based survey of adults (aged 18+), using strati-
fied random sampling (by sex and age) to ensure demographic representation of the 
Brazil adult population. Caregivers were compared with non-caregivers on select 
comorbidities considered potential outcomes of caregiving, plus sociodemographic 
characteristics, health characteristics and behaviors, and Charlson comorbidity index 
(CCI) scores. Binary logistic regression models assessed comorbidities associated with 
caregiving, adjusting for potential confounds (CCI, age, gender, education, income, 
insurance, and marital status). Results: Among 10,853 respondents (caregivers 
[n= 209]; non-caregivers [n= 10,644]), caregivers were on average 42.1 years old, and 
53% were female, 52% married/living with a partner, 87% insured, and 42% living with 
1+ children in the household. Caregivers vs. non-caregivers were more frequently 
obese, smokers, insured, employed, and with college education or above, and they 
had higher CCI scores and higher income, all p < .05. Adjusting for covariates, caregiv-
ing was associated with significantly increased risk of depressive symptoms (odds 
ratio [OR] = 2.008), major depressive disorder (OR= 1.483), anxiety (OR= 1.714), insomnia 
(OR= 1.644), hypertension (OR= 1.584), pain (OR= 1.704), and diabetes (OR= 2.103), all 
p< .015. cOnclusiOns: This is the first study on caregivers for persons with demen-
tia in Brazil using a large dataset (NHWS). Being a caregiver (compared with non-
caregiver) is a predictor of overall psychiatric and clinical disorders in this sample. The 
online survey format provides certain sampling advantages but may under-represent 
caregivers without access/comfort with online technology. Direct treatment and poli-
cies to help caregivers are needed in Brazil.
PND68
the value of DIagNostIc tests for alzheImer’s DIsease: DIscrete-
choIce exPerImeNt aND coNtINgeNt-valuatIoN
Mühlbacher A.C.1, Johnson F.R.2, Yang J.C.3, Happich M.4
1University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany, 2Triangle Health 
Preference Research, Chapel Hill,, NC, USA, 3RTI Health Solutions, Research Triangle Park, NC, 
USA, 4Eli Lilly and Company, Bad Homburg, Germany
Objectives: Despite the existence of standardized medical criteria, clinical diagno-
sis of Alzheimer’s disease remains difficult. Lack of diagnostic certainty or possible 
distress related to positive results could limit application of new testing technolo-
gies. Independent of the therapeutic value of prevention or cure, however, diagnostic 
information could have value in informing contingency planning or have intrinsic 
value: the value of “just knowing”. This paper aims to quantify respondents’ prefer-
ences for obtaining AD diagnostic tests and to estimate the perceived value of AD 
test information. MethOds: Discrete-choice experiment (DCE) and contingent-
valuation (CV) questions were administered to N= 1301 respondents aged 60 years 
or older in Germany and the United Kingdom. 12 pairs of virtual AD diagnostic tests 
were presented (defined by test type, test precision defined by false-positive or false-
negative test results, and test cost) and a no-test alternative. DCE questions were 
based on a predetermined experimental design. A double-bounded, dichotomous-
choice CV question was used to further elicit willingness to take an AD test and pay 
for it. Choice data of respondents interested in taking a test were analyzed using 
random-parameters logit. A probit model characterized respondents who were not 
willing to take a test. Results: Most respondents in both countries had a posi-
tive value for AD diagnostic test information. Most respondents who indicated an 
interest in testing in Germany (N= 631) and the UK (N= 670) preferred brain imaging 
without radioactive marker, followed by brain imaging with radioactive marker 
and then spinal tap. Diagnostic tests with better precision were preferred. German 
respondents had relatively greater heterogeneous preferences and lower money-
equivalent values for test features compared to UK respondents. cOnclusiOns: 
Respondents preferred less invasive diagnostic procedures and tests with higher 
accuracy. Diagnostic test accuracy was more important than test type. Respondents 
expressed a willingness to pay up to € 700 to receive a less invasive test with the 
highest accuracy.
PND69
the humaNIstIc aND ecoNomIc burDeN of PartIal oNset seIzures IN 
the euroPe fIve aND brazIl usINg a PatIeNt survey
Gupta S.1, Forsythe A.2, Pomerantz D.1, Tsong W.2
1Kantar Health, Princeton, NJ, USA, 2Eisai Inc., Woodcliff Lake, NJ, USA
Objectives: The aim of this study was to understand the current impact of partial 
onset seizures (POS) on health outcomes and costs. MethOds: Patients were identi-
fied from the 2010 & 2013 5EU and 2011-2012 Brazil National Health and Wellness 
Survey, a nationally represented, internet-based survey of adults (18+ years). 
Patients self-reported a diagnosis of epilepsy with POS and were categorized into 
≥ 1 seizure per week, 1-3 seizures per month, 1-4 seizures per year, < 1 seizure per 
year (reference). Patients completed the SF-36v2 (mental (MCS), physical component 
summary (PCS)), SF-6D (health utility), Work Productivity and Activity Impairment 
Questionnaire and reported on resource utilization in the past six months. Costs 
were estimated from the literature. Generalized linear regression analyses were 
conducted controlling for covariates (e. g., age, gender, marital status, comorbidities, 
years diagnosed with epilepsy). Results: There were 175 patients in the 5EU and 
32 in Brazil, 11.1% reported ≥ 1 seizures/week, 7.7% reported 1-3 seizures/month, 
26.1% 1-4 seizures/year, and 55.1% < 1seizures/year. MCS, PCS, utilities, productivity 
categorized into three groups: placebo, PR-fampridine responders (those with 
a mean improvement from baseline in the 12-item MS walking scale [MSWS-
12] of ≥ 8 points over 24 weeks), and PR-fampridine nonresponders (those with 
worsening, no change, or < 8 points improvement in MSWS-12). Changes from 
baseline were calculated for the EQ-5D utility index and visual analogue scale 
(VAS) by visit and over the 24 weeks. Within-group and pairwise comparisons 
were assessed based on the least square (LS) means using analysis of covariance 
(ANCOVA) models adjusting for baseline EQ-5D scores. Results: The placebo 
patients (n= 64), responders (n= 33), and nonresponders (n= 35) were similar in 
baseline age, race, weight, and number of relapses in the past 1 and 2 years. 
The responders had higher mean baseline EQ-5D utility (0.56 vs. 0.51 and 0.52, 
respectively) and VAS (62.9 vs. 59.1 and 60.5, respectively) scores than the placebo 
patients and nonresponders. Over the 24 weeks, the EQ-5D utility score improved 
in the responders (mean change: 0.06, 95% CI: [0.01, 0.12]) but worsened in the 
placebo patients (mean change: -0.03,95% CI: [-0.07, 0.01]) and nonresponders 
(mean change: -0.07,95% CI: [-0.12, -0.02] ). Similar trends were observed in the VAS 
scores although the differences within groups were generally not statistically sig-
nificant. cOnclusiOns: PR-fampridine 10 mg tablets demonstrated significantly 
greater improvement in QoL among responders, despite starting from higher base-
line EQ-5D scores, than the placebo or nonresponder groups.
PND65
the burDeN of PrImary geNeralIzeD toNIc-cloNIc seIzures IN euroPe 
aND the uNIteD states: aN aNalysIs of the NatIoNal health aND 
wellNess survey
Gupta S.1, Forsythe A.2, Pomerantz D.1, Tsong W.2
1Kantar Health, Princeton, NJ, USA, 2Eisai Inc., Woodcliff Lake, NJ, USA
Objectives: Many prescription medications are available to treat Primary 
Generalized Tonic-Clonic (PGTC) seizures. The objective is to understand the 
impact of PGTC on health outcomes. MethOds: Data from the 2011-2013 U.S. and 
2010 & 2013 5E.U. National Health and Wellness Survey (NHWS) were analyzed. 
The NHWS is self-administered, internet-based survey of a nationwide sample of 
adults (18+ years) stratified to represent the demographic composition of each 
country. Patients self-reported a diagnosis of epilepsy with PGTC and were grouped 
as ≥ 1 seizure per week, 1-3 seizures per month, 1-4 seizures per year, < 1 seizure 
per year (reference). Patients provided information on health status (mental (MCS), 
physical component summary (PCS), and SF-6D (health utility) from the SF-36v2), 
resource utilization in the past six months and productivity loss (Work Productivity 
and Activity Impairment Questionnaire). Costs were estimated from the literature. 
Regression analyses were conducted controlling for covariates (e. g., age, gender, 
marital status, comorbidities, years diagnosed with epilepsy). Results: There were 
782 patients in the U.S. and 418 in the 5EU. In both geographies the proportion of 
employed respondents decreased as frequency of seizures increased. Over 75% of 
patients in both geographies were taking a prescription medication for epilepsy. 
After adjustments, patients reporting < 1 seizure per year had greater PCS, health 
utilities, lower activity impairment, fewer emergency room visits and lower total 
direct costs compared to the other three seizure groups (p< 0.05 both geographies). 
Among employed patients, patients reporting < 1 seizure per year had the lowest 
overall work impairment (p< 0.05 both geographies). For all employable patients 
(18-60 years) indirect costs were highest for the ≥ 1 seizure per week group (p< 0.05 
both geographies). cOnclusiOns: Results suggest a significantly higher economic 
and humanistic burden in patients with more frequent seizures. PGTC patients are 
very much in need of newer treatment options.
PND66
factors assocIateD wIth caregIver’s burDeN IN relaPsINg-remIttINg 
multIPle sclerosIs aND satIsfactIoN wIth curreNt theraPIes.  
ms-feelINg stuDy
Balaña M.1, Fabregas M.2, Meca-Lallana J.3, Mendibe M.4, Garcia E.1
1Novartis Farmaceutica, Barcelona, Spain, 2TFS Develop S.A., Barcelona, Spain, 3Hospital Virgen 
de la Arrixaca, Murcia, Spain, 4Hospital de Cruces, San Vicente de Barakaldo, Spain
Objectives: To describe the characteristics and burden of caregivers and patients 
affected by relapsing-remitting multiple sclerosis (RRMS), and to describe their sat-
isfaction with treatment. MethOds: Multicenter, observational, cross-sectional 
study in RRMS patients≥ 18 years (y), treated for ≥ 1y. Burden was assessed with 
the Zarit Burden Interview. Other measures were: Center for Epidemiologic Studies 
Depression Scale, short form (CESD-7); and treatment satisfaction of caregivers (ad-
hoc questionnaire) and patients (Treatment Satisfaction Questionnaire for Medication 
(TSQM)). Results: We included 180 patients (mean (SD) age 41 (11) y, 66% female) and 
caregivers (47 (12) y, 56% female, 67% economically active). Most caregivers were rela-
tives (59% partner; 25% parent; 9% brother or sister) and lived with the patient (86%); 
37% helped with the medication. Median (Q1, Q3) time since diagnosis was 7 (4,10) y 
and between diagnosis and first treatment, 0.3 (0.2, 1.3) y. Most patients received 
monotherapy with interferon beta (51%), glatiramer acetate (20%), natalizumab (14%) 
or fingolimod (7%); 15.6% received ≥ 2 drugs. Median EDSS was 2.5 (1,4). According to 
the Zarit Interview, 19% of caregivers had some degree of burden (median: 10 (7,15)). 
Factors associated with burden were: EDSS (mean (SD) in caregivers with burden vs 
without burden, respectively: 4.0 (2.1) vs 2.6 (1.9), p< 0.0005), years of caregiving (mean: 
4.0 (4.5) vs 2.7 (4.5) y, p= 0.005), daily hours dedicated to patient (10.8 (12.1) vs 5.8 (4.6) 
hours, p= 0.038), and > 1 drug (39% of burden when patients take≥ 2 drugs vs 16% with 
monotherapy, p= 0.004). Other caregiver’s characteristics (age, gender, professional 
activity, relationship with patient or cohabitation) were not significantly associated. 
28.2% of caregivers had depression (CESD-7≥ 15). Both patients (90% satisfied or very 
satisfied according to the TSQM) and caregivers (mean of 7.6 (2.3) on a scale from 
0-10 [maximum satisfaction]) were quite satisfied with treatment. cOnclusiOns: 
In the RRMS population with moderate disability, around 2 in 10 caregivers have some 
degree of burden, and 1 in 4 suffer depression. The burden increases proportionately 
with disease severity and number of medications administered. Overall, patients and 
caregivers are satisfied with treatment.


PND68 The Value of Diagnostic Tests for Alzheimer's Disease: Discrete-Choice Experiment and Contingent-Valuation 

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PND68 The Value of Diagnostic Tests for Alzheimer's Disease: Discrete-Choice Experiment and Contingent-Valuation

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