�Alzheimer�s disease: Update� by F37qYuXI

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									    Cholinesterase Inhibitors in a real-world coverage study
                        Revised outline

 Introduction: measurement for drug policymakers and assessment tools for
  clinicians

 What caregivers think of cholinesterase inhibitors (KAREN KOBAYASHI)

 Trends in utilization and costs of services associated with introduction of drug
  coverage for cholinesterase inhibitors (MALCOLM MACLURE)

 Clinical epidemiology: Who benefits? How do we know? (LYNN BEATTIE)

 Alzheimer’s Drug Therapy Initiative: Seniors Medication Study (GING-YUEK
  ROBIN HSIUNG)

 The ADTI CLIMAT (Clinical Meaningfulness in Alzheimer Disease Treatment)
  study (CLAUDIA JACOVA)

 ADTI: Current view and future directions
      British Columbia –
 Alzheimer’s disease Therapy
       Initiative (ADTI)

   MEASUREMENTS FOR DRUG
POLICYMAKERS AND ASSESSMENT
    TOOLS FOR CLINICIANS
             Disclosures (PL)

 Honoraria and participation in advisory
  board meetings (Janssen, Novartis, Pfizer)
 Clinical trials sponsored by BMS, Elan,
  Janssen, Pfizer
Alzheimer’s Disease Therapy Initiative

• July 2006 – Meeting with key stakeholders
  - Community members

  - Clinicians

  - Government representatives

• Coverage for cholinesterase inhibitors
  provided for B.C. residents who are in mild
  to moderate stages of Alzheimer’s disease
• Concurrently, gathering evidence on
  “effectiveness” of medications and the
  program itself
 Alzheimer’s Disease Therapy Initiative

 Over the following year, development of
  educational and medication program
• BC PharmaCare launched ADTI program in
  October 2007
 –   4-phase project, now in third & fourth phase
• PharmaCare providing funding for ADTI until
 March 2012
       Dementia Education Strategy

 Sharing knowledge and experience between
  physicians and healthcare professionals and
  public
 Conferences, public forums, literature
 Workshops
 http://www.health.gov.bc.ca/pharmacare/adti/careg
 iver/cognitive.html
                Special Authority

 Special authority coverage
 Three versions of form
   Initiation
   Renewal/switching for lack of efficacy
   Switching for tolerability




         http://www.healthservices.gov.bc.ca/pharme/sa/adti.html
                                             604   123-4567
Dr. Oz
1234 1st Ave, Anywhere, BC V7X 4H5
                                     12345   604   123-4568
Renewal or Switching Due to Lack of Effect
              Patient Assessment

• Four areas – cognition, function (basic and
  instrumental activities) and behaviour
• Clinicians are asked to assess the change in a
  patient’s ability over six months
 –   Assigning a score of + 1, 0 or - 1 for each area
• Clinicians are asked to make a judgment of
 improvement or decline, taking into account
 clinical factors (OPAR)
 •   Very much, much or minimal improved, no change or
     minimal, much or very much worse
              ADTI Ongoing Studies

• The Caregiver Study
 -   What are the benefits, if any, of ChEI from perspective
     of family caregivers for patients and for themselves and
     how do they compare with clinical assessments of
     these medications?
• Utilization and Cost Study
 –   Trends of ChEIs and health services use before and
     during ADTI, with aim of estimating cost-effectiveness
• Clinical Epidemiology
 –   Who benefits from ChEI including effectiveness of
     switching, tolerability and treatment trajectories?
                 ADTI Studies

• The Senior’s Medication Study
 -   Who benefits from continued treatment and
     consequences of treatment termination?
• The CLIMAT
 -   How can a positive response to ChEIs be
     characterized on a scale of clinically
     meaningful change? Can its items be used in
     situations of clinical equipoise?

								
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