Cost-effectiveness of pharmacological therapies for people with Alzheimer's disease and other dementias: a systematic review and meta-analysis.

OBJECTIVES: This study aims to synthesize the empirical economic evidence of pharmaceutical therapies for people with dementia. STUDY DESIGN: Systematic review and meta-analysis. Literature evaluating the costs and effects of drug therapies for dementia was indexed until December 2021. Quality of study was assessed using the Cochrane Risk of Bias Tool and Consensus on Health Economic Criteria list. Cost data were standardized to 2020 US dollars and analyzed from healthcare service and societal perspectives. Random-effects models were used to synthesize economic and clinical data, based on mean differences (MDs) and standardized MDs. RESULTS: Ten unique studies were identified from 11,771 records. Acetylcholinesterase inhibitors (AChEIs) and memantine improved dementia-related symptoms, alongside nonsignificant savings in societal cost (AChEIs: MD-2002 [- 4944 ~ 939]; memantine: MD-6322 [- 14355 ~ 1711]). Despite decreases in cost, antidepressants of mirtazapine and sertraline and second-generation antipsychotics were limited by their significant side effects on patients' cognitive and activity functions. Subgroup analysis indicated that the impacts of AChEIs on cost were affected by different analytical perspectives, follow-up periods, and participant age. CONCLUSIONS: AChEIs and memantine are cost-effective with improvements in dementia-related symptoms and trends of cost-savings. More empirical evidence with non-industrial sponsorships and rigorous design in different settings is warranted.

Supporting Informal Caregivers of People With Dementia in Cost-Effective Ways: A Systematic Review and Meta-Analysis.

OBJECTIVES: Caring for persons with dementia is a heavy burden for informal caregivers. This study aimed to appraise the economic evidence of interventions supporting informal caregivers of people with dementia. METHODS: Literature was searched, and trial-based studies evaluating the costs and effects of interventions supporting informal caregivers of people with dementia were included. Cost data were analyzed from both healthcare and societal perspectives. Random-effects models were used to synthesize cost and effect data, based on mean differences (MDs) or standardized MDs. RESULTS: Of 33 eligible studies identified from 48 588 records, 14 (42.4%) showed net savings in total cost regardless of analytical perspectives. Among 22 studies included in meta-analyses, caregiver-focused psychosocial interventions showed improvements in caregivers' psychological health (n = 4; standardized MD 0.240; 95% confidence interval 0.094-0.387); nevertheless, the increases in societal cost were significant (n = 5; MD 3144; 95% confidence interval 922-5366). Psychological intervention and behavioral management engaging patient-caregiver dyads showed positive effects on caregivers' subjective burden, also with increases in total cost. Subgroup analyses indicated that the inclusion of different intervention components, the caregiver characteristics, and the follow-up periods could affect the costs and effects of interventions supporting informal caregivers. CONCLUSIONS: Psychosocial interventions directed at informal caregivers and dyad-based psychological and behavioral interventions are effective but also expensive. The use of these interventions depends on the society's willingness to pay. More comprehensive economic evidence of interventions supporting informal caregivers is required, and the design of intervention should focus more on different intervention components, characteristics of patients and caregivers, and healthcare systems.

Diagnostic accuracy of dementia screening tools in the Chinese population: a systematic review and meta-analysis of 167 diagnostic studies.

BACKGROUND: The rate of undetected dementia is high in China. However, the performance of dementia screening tools may differ in the Chinese population due to the lower education level and cultural diversity. This study aimed to evaluate the diagnostic accuracy of dementia screening tools in the Chinese population. METHODS: Eleven electronic databases were searched for studies evaluating the diagnostic accuracy of dementia screening tools in older Chinese adults. The overall diagnostic accuracy was estimated using bivariate random-effects models, and the area under the summary receiver operating characteristic curve was presented. RESULTS: One hundred sixty-seven studies including 81 screening tools were identified. Only 134 studies qualified for the meta-analysis. The Mini-Mental State Examination (MMSE) was the most commonly studied tool, with a combined sensitivity (SENS) and specificity (SPEC) of 0.87 (95%CI 0.85-0.90) and 0.89 (95%CI 0.86-0.91), respectively. The Addenbrooke's Cognitive Examination-Revised (ACE-R) (SENS: 0.96, 95%CI 0.89-0.99; SPEC: 0.96, 95%CI 0.89-0.98) and Montreal Cognitive Assessment (MoCA) (SENS: 0.93, 95%CI 0.88-0.96; SPEC: 0.90, 95%CI 0.86-0.93) showed the highest performance. The General Practitioner Assessment of Cognition (GPCOG), Hasegawa's Dementia Scale and Cognitive Abilities Screening Instrument had performances comparable to that of the MMSE. The cut-off scores ranged widely across studies, especially for the MMSE (range: 15-27) and MoCA (range: 14-26). CONCLUSIONS: A number of dementia screening tools were validated in the Chinese population after cultural and linguistical adaptations. The ACE-R and MoCA had the best diagnostic accuracy, whereas the GPCOG, with an administration time < 5 minutes, could be considered as a rapid screening tool.

Psychometric validation of the Chinese digital health literacy instrument among Chinese older adults who have internet use experience.

INTRODUCTION: In this digital age, the Internet has become a major source of health information, and electronic health (eHealth) literacy becomes increasingly important for older individuals to properly use the extensive eHealth resources for self-care. A valid and reliable tool for assessing older people's eHealth literacy would help healthcare workers identify those disadvantaged groups in digital health and provide relevant health education. OBJECTIVES: This study aimed to evaluate the psychometric properties of the Chinese version of DHLI in assessing eHealth literacy among older adults in China. METHODS: A web-based, cross-sectional study was conducted among 277 Chinese older adults from September to November 2021. Two weeks after the first completion, 62 of them answered the C-DHLI again. The reliability (e.g. internal consistency and test-retest reliability), factorial structure and validity (i.e. content validity and convergent validity) of the C-DHLI were evaluated based on the survey data. RESULTS: The results demonstrated good internal consistency (Cronbach's alpha: 0.94) and test-retest reliability (total intraclass correlation coefficient [ICC]: 0.94) of the C-DHLI. Principal component analysis revealed that the 18 items of C-DHLI loaded on three factors, accounting for 74.69% of the total variance; CFA supported its three-factor structure with good model fits. Convergent validity was examined by the significant associations between C-DHLI and C-eHEALS (r = 0.61), health literacy (r = 0.56), and whether having used the Internet for health information (ρ = 0.43) (ps <.001). A cut-off score of 45 was recommended for determining higher and lower literacy using the C-DHLI, with the area under curve of 0.82 (95% CI = 0.77-0.88). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The C-DHLI showed good psychometric performance in assessing eHealth literacy among Chinese older adults. The findings can support healthcare professionals to effectively measure eHealth literacy among older adults and conduct tailored eHealth interventions or training.

Psychometric performance of proxy-reported EQ-5D youth version 5-level (EQ-5D-Y-5L) in comparison with three-level (EQ-5D-Y-3L) in children and adolescents with scoliosis.

OBJECTIVES: To assess the psychometric performance of proxy-reported EQ-5D-Y-5L (Y-5L) in comparisons with EQ-5D-Y-3L (Y-3L) administered by caregivers of patients with juvenile (JIS) or adolescent idiopathic scoliosis (AIS). METHODS: A consecutive sample of caregivers of JIS or AIS patients were recruited. Redistribution property, ceiling effects, and discriminative power were examined. Known-group validity was determined by examining their ability to detect differences across clinical known groups. Test-retest reliability was assessed using intraclass correlation coefficient (ICC) for EQ-VAS score and Gwet's agreement coefficient (GAC) and percentage agreement (PA) for dimension responses. Furthermore, subgroups were analyzed for comparing test-retest reliability. RESULTS: A total of 130 caregivers were involved in the study. Consistencies between proxy-reported Y-3L and Y-5L were very high for all dimensions (93.8-99.2%). The ceiling effect in the Y-5L was slightly reduced in four dimensions (AR: 0.8-2.3%) whereas increased in "Having pain/discomfort". Greater informativity was found in the Y-5L than the Y-3L. In known-group comparisons of curvature magnitude, curvature type, and treatment modality, Y-5L and Y-3L dimension scales showed hypothesized results. For example, more full-health responses were found in the mild Cobb angle group (Y-5L: 63.1%; Y-3L: 62.2%) than the severe Cobb angle group (Y-5L: 55.6%, Y-3L: 55.6%). EQ-VAS score exhibited low test-retest reliability (ICC: 0.41), whereas dimension scales of both instruments showed satisfactory test-retest reliability (GAC ≥ 0.7 and PA ≥ 70% for all). In most known groups, hard-to-observe dimensions were more reliable for proxy-reported Y-5L than Y-3L. CONCLUSION: Both the proxy-reported Y-5L and Y-3L are valid and reliable instruments for assessing the HRQoL of JIS or AIS patients.

Integrated Care for Multimorbidity Population in Asian Countries: A Scoping Review.

Background: The complex needs of patients with multiple chronic diseases call for integrated care (IC). This scoping review examines several published Asian IC programmes and their relevant components and elements in managing multimorbidity patients. Method: A scoping review was conducted by searching electronic databases encompassing Medline, Embase, Scopus, and Web of Science. Three key concepts - 1) integrated care, 2) multimorbidity, and 3) Asian countries - were used to define searching strategies. Studies were included if an IC programme in Asia for multimorbidity was described or evaluated. Data extraction for IC components and elements was carried out by adopting the SELFIE framework. Results: This review yielded 1,112 articles, of which 156 remained after the title and abstract screening and 27 studies after the full-text screening - with 23 IC programmes identified from seven Asian countries. The top 5 mentioned IC components were service delivery (n = 23), workforce (n = 23), leadership and governance (n = 23), monitoring (n = 15), and environment (n = 14); whist financing (n = 9) was least mentioned. Compared to EU/US countries, technology and medical products (Asia: 40%, EU/US: 43%-100%) and multidisciplinary teams (Asia: 26%, EU/US: 50%-81%) were reported less in Asia. Most programmes involved more micro-level elements that coordinate services at the individual level (n = 20) than meso- and macro-level elements, and programmes generally incorporated horizontal and vertical integration (n = 14). Conclusion: In the IC programmes for patients with multimorbidity in Asia, service delivery, leadership, and workforce were most frequently mentioned, while the financing component was least mentioned. There appears to be considerable scope for development. Highlights: First scoping review to synthesise the key components and elements of integrated care programmes for multimorbidity in Asia.All programmes emphasized 'distinctive service delivery', 'leadership', and 'workforce' components.'Financing' component was least mentioned in identified integrated care programmes.

Feasibility of Proxy-Reported EQ-5D-3L-Y and Its Agreement in Self-reported EQ-5D-3L-Y for Patients With Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To compare feasibility of self-reported and proxy-reported youth version of EuroQoL Five-Dimension Three-Level Questionnaire (EQ-5D-3L-Y), to estimate the agreement of health outcome between patients with adolescent idiopathic scoliosis (AIS) and their proxies, and to examine factors that may affect patient-proxy agreement. SUMMARY OF BACKGROUND DATA: The EQ-5D-3L-Y questionnaire has both self-reported and proxy-reported versions. Despite previous studies have indicated that proxies tended to respond with higher or lower levels of severity in specific dimensions than patients report, the level of agreement between children with AIS and their proxies remained unknown. METHODS: A consecutive sample of patients with AIS and their caregivers were recruited. Feasibility was tested according to the proportion of missing responses. Agreements between self-report and proxy EQ-5D-3L-Y were evaluated using percentage agreement, Gwet agreement coefficients and the intraclass correlation coefficients. Linear regressions and logistic regressions were conducted to assess the factors associated with the agreement in health outcome between self-reported and proxy-reported EQ-5D-3L-Y. RESULTS: A total of 130 patient-proxy pairs were involved in the study. Agreement of EQ-5D-3L-Y responses between the self-report and proxy version was good for "Feeling worried/sad/unhappy" dimension, and very good for other dimensions. Poor agreement in visual analog scale score was observed between patient and proxy versions. Proxy's education level, patient's curvature type, and treatment modality were the significant determinants of the agreement in "Mobility," "usual activities," and "pain/discomfort" dimension, respectively. CONCLUSION: Proxy-reported EQ-5D-3L-Y demonstrates good feasibility and satisfactory agreement with patient version. Proxy's education appears to have positive influence in agreement between patient-proxy dyads. LEVEL OF EVIDENCE: 2.

Responsiveness of EQ-5D Youth version 5-level (EQ-5D-5L-Y) and 3-level (EQ-5D-3L-Y) in Patients With Idiopathic Scoliosis.

STUDY DESIGN: Prospective cohort study OBJECTIVE.: The aim of this study was to evaluate the responsiveness of EQ-5D Youth version (EQ-5D-Y) 5-level and 3-level in patients with idiopathic scoliosis SUMMARY OF BACKGROUND DATA.: A new version of EQ-5D-Y increasing the number of response levels from 3 (3LY) to 5 (5LY) has been recently introduced. Although the validity and reliability of 5LY and 3LY for use in idiopathic scoliosis patients are compared, responsiveness of two questionnaires among children and adolescents is unknown. METHODS: A total of 129 children or adolescents attending the spine clinics of a tertiary hospital in Hong Kong, China, completed 3LY and 5LY. At 3-month follow-up, 110 (85.2%) patients completed two EQ-5D-Y questionnaires, and the single-item Global Rating on Change Scale determining "worsened,", "unchanged,", or "improved" global health. Among those indicating "unchanged" in global health from baseline to follow-up, agreement in responses to each 3LY and 5LY item was examined. Mean changes in EQ-5D-Y scores during the past 3 months in patients with "worsened," "unchanged," and "improved" health were calculated. RESULTS: Most patients (82.7%) reported no change in global health, whereas about 12.7% and 4.5% of them felt better and worse, respectively, compared to baseline. Among those reporting "unchanged health," the "Looking after myself" item exhibited the largest proportion of agreement in responses (5LY: 96.36%; 3LY: 95.50%), followed by "Mobility" (5LY 90.91%; 3LY 90.99%), "Usual activities" (5LY 83.64%; 3LY 87.39%), "Pain/discomfort"(5LY 68.18%; 3LY 76.58%), and "Feeling worried/sad/unhappy" (5LY 66.36%; 3LY 72.07%). In the "improved" or "worsened" group, the 3-month follow-up 5LY and 3LY scores were higher or lower compared with baseline, respectively. CONCLUSION: The 5LY is demonstrated as responsive as the 3LY for patients with idiopathic scoliosis. LEVEL OF EVIDENCE: 2.