Polyxane Mertzanis

Alzheimer’s disease treatment: Assessing caregiver preferences for mode of treatment delivery

IntroductionManagement of patients with Alzheimer’s Disease (AD) can exert a substantial burden upon caregivers. As new modes of treatment administration are developed, it is important to assess caregiver satisfaction and preference in a standardized manner. This study describes the development of the Alzheimer’s Disease Caregiver Preference Questionnaire (ADCPQ) to assess AD caregivers’ satisfaction with and preference for patch or capsule treatments in AD patients.MethodsTwenty-five published articles (1987-2002) were reviewed to identify potential ADCPQ domains. Three caregiver focus groups (n=24) were conducted to develop a first draft of the questionnaire. After evaluating the acceptance of ADCPQ to caregivers through in-depth interviews (n=10), its psychometric properties were assessed using data from 986 patients enrolled in a multicenter, randomized, double-blind, four-arm, placebo- and active-controlled, 24-week trial.ResultsFocus groups indicated that caregivers expressed dissatisfaction with current AD treatment routines including limitations related to: efficacy, administration schedule, number of pills, adherence to treatment, side effects, and taking pills. In-depth interviews with caregivers found the ADCPQ to be comprehensible with an acceptable layout. The resultant ADCPQ comprises three modules: A) baseline, 11 items assessing treatment expectations; B) week 8, 33 items on satisfaction and preferences with treatment options; C) week 24, 10 items assessing overall opinions of treatment options. Missing data per item was low (≤0.3%) and domain internal consistency reliability was good (0.71–0.91). Preference items were also valid when evaluating concordance and discordance between convenience and satisfaction patch and capsule domain scores.ConclusionAD treatment puts a significant strain on caregivers. New modes of treatment delivery may be less burdensome to caregivers, thereby increasing satisfaction and potential treatment adherence. The ADCPQ was well accepted by AD caregivers and its domains demonstrated satisfactory psychometric properties. The ADCPQ is a useful tool to understand caregiver preferences for patch versus oral therapies in AD.

Measurement strategies for indirect costs in economic evaluations

Considerable research has been undertaken on the different methods for valuing work absences and productivity losses (e.g., human capital vs. friction costing). However, investigation related to the best way to capture this information directly from trial participants or through surveys has been inadequate. The collection of information that may be used in providing estimates of indirect costs is problematic for a number of reasons such as the presence of poor questionnaire design, a lack of psychometric testing and accessible validating data and the potential for recall errors. In this review, the measurement methods of lost time for work activities are examined. Issues in the validity of existing instruments and recall periods are explored. Based on a review of the literature, the relevance of generic and specific methods of measuring work losses are assessed.