Scratching my head...

A study just published in Alzheimer's and Dementia looked interesting, but it left me a little puzzled.  The study, "Assessing cost-effectiveness of early intervention in Alzheimer's disease: An open-source modeling framework," described development of a framework for assessing cost-benefit for as yet unknown future treatments of AD.

This year's Alzheimer's Association Facts and Figures Report marveled at the tsunami of cost that AD will inflict on the US in coming decades, and spoke to how much can be saved if AD is identified and treated early -- either in the MCI stage or even the pre-clinical stage.  The problem is, there are no effective treatments of the type considered -- drug or other therapy.  Also, when such a treatment arrives (assuming it does), how much will it cost in relation to what benefit it will provide?  The study considered the cost to individual families as well as the cost to society in general.  The study reported on development of an approach to assessing this.

One thing that struck me about the article was what seemed to be a badly outdated understanding of where the search for this therapy stands.  It acknowledged the painful journey to such a drug or other intervention, but then cited old research positing the possibility that the human monoclonal antibody treatment Aducanumab might finally be that therapy.  Huh?

Their references about hope for Aducanumab were old, from before the last round of trials were abandoned.  We discussed this in March.  Perhaps they're holding onto the possibility that applying the therapy in the pre-clinical stage might produce better results.  But there seem to me to be more doubters than believers on that.  The study did talk to treatments that address AD in the pre-clinical and MCI stages.  In fact, it modeled disease progression through the three recognized stages of the disease -- pre-clinical, MCI, and Alzheimer's dementia.

My sense is that people anticipate that an effective treatment for the pre-clinical and MCI stages of AD will be unlikely to bring someone back who has advanced into Alzheimer's dementia.  

My takeaway from the study is that this is a tool that will be on the shelf until the day we have an effective, but likely expensive treatment.  At that point, when many unknowns have been clarified, it can be used to determine how to ration the treatment -- at what point is spending more money not returning a benefit.