Presentation (CTI)

OBJECTIVES: Alzheimer’s disease (AD) is a progressive condition that imposes growing economic and societal burdens. With increasing interest in non-pharmacologic options such as acupuncture, especially in long-term care settings, there is a need to understand how such interventions are evaluated economically. This review aims to support future evaluations of acupuncture by examining the current landscape of economic evaluations in AD.
METHODS: A systematic review was conducted to identify full economic evaluations of AD interventions. Searches were performed in MEDLINE, EMBASE, and CENTRAL, with the most recent search completed on May 1, 2025. Inclusion criteria encompassed studies that conducted cost-effectiveness, cost-utility, or cost-benefit analyses targeting AD, regardless of intervention type or setting. Data were extracted on country, intervention type, and data sources for costs, utilities, and transition probabilities.
RESULTS: Thirty-four studies were included. Most originated from high-income countries, particularly the United States, Sweden, and the United Kingdom. Earlier studies (pre-2010) frequently evaluated cholinesterase inhibitors such as donepezil, while later studies incorporated memantine, rivastigmine, and non-pharmacologic approaches, including caregiver training and cognitive therapy. More recent evaluations addressed disease-modifying treatments such as gene therapy and monoclonal antibodies.
Cost components typically included both direct (e.g., medical services, medications) and indirect costs (e.g., caregiver time, productivity loss), drawn from national health databases, insurance claims, or literature. Utility measures were most often based on EQ-5D instruments; others used Alzheimer-specific scales or values derived from cohort studies. Transition probabilities were obtained from clinical trials (e.g., EMERGE/ENGAGE), registry data, or modeled using cognitive metrics such as MMSE scores. Some models incorporated disease progression through Markov or discrete event simulation frameworks.
CONCLUSIONS: Economic evaluations in AD reflect shifting treatment paradigms and methodological innovation. These findings provide essential groundwork for future cost-effectiveness studies of acupuncture and underscore the importance of including caregiver costs and societal perspectives.