Global & National Policy on Dementia & Alzheimer s Disease

Transcription

1 Global & National Policy on Dementia & Alzheimer s Disease Associate Professor Vorapun Senanarong, BSc, MD, DTM&H(London), FRCP(London) Professor Vorapun Senanarong, BSc, MD, DTM&H(London), FRCP(London) Dementia burden Global dementia observatory Death in dementia, risk factors in dementia Global dementia action plan Research plan National Drug list 1

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3 Distribution of total societal costs (%) by World Bank Income level Composition of health expenditure measured in US$ Heavy reliance on out of pocket expenditures leads to financial barriers for poor. WHO/NHA Policy Highlight No.2/May Geneva, World Health Organization, 2011 ( accessed 12 February 2012) 3

4 Factors related to caregiver strain World Alzheimer s Report London, Alzheimer s Disease International, 2009 The integrated caregiving system WHO2012 4

5 Original EURODEM prevalence estimates of dementia, no major differences between and within countries in prevalence of dementia cf other NCD (Hofman et al) Dementia and severe cognitive impairment before death by age (dying within one year of interview UK) % Demented at death Age group 5

6 Cardiovascular disease mortality trends for males and females (United States: ). Roger V L et al. Circulation 2011;123:e18-e209 Copyright American Heart Association Cardiovascular disease (CVD) deaths versus cancer deaths by age (United States: 2007). Roger V L et al. Circulation 2011;123:e18-e209 Copyright American Heart Association 6

7 Graph showing growing number of Alzheimer s disease related deaths compared to other diseases between 2000 and 2010 (percentage change) Alzheimer's Association 2013: Alzheimer' Disease Facts & Figures. Wortmann Alzheimer s Research & Therapy 2012, 4:40 Age and sex adjusted survival in healthy men and women years EPIC Norfolk by health behaviour score P< SCORE Relative risk Cum Survival YEARS Score Score 0-4 Equivalent survival difference 14 years chronological age 1 Non smoker 1 Alcohol >0 <14 units/wk 1 Not inactive 1 Blood vitamin C >50 umol/l (5 servings fruit and vegetables daily) Khaw et al PLoS Med 2008 Jan 8;5(1):e12. 7

8 Prevalence of dementia at death by educational level (MRC CFAS) % Demented at death <10 years >=10years Years of full time education Brayne et al, PLoS Med ApoE47% Early life 8% Less education 5% Percentage reduction if this risk is eliminated Midlife Life course model of contribution of modifiable risk factors to dementia Numbers are rounded to nearest integer. Figure shows potentially modifiable or nonmodifiable risk factors. 9% 2 % 1 % 5% 4% 3% Late life 2% 1% Gill Livingston, Andrew Sommerlad, Vasiliki Orgeta, at al. Dementia prevention, intervention, and care. Lancet (17) % 65% Potentially modifiable risks Potentially nonmodifiable risks 8

9 Proportion of CPRD population diagnosed with dementia in the UK by region (A) and age (B) between July, 2005, and June, 2015 Time(yr) Clinical Practice Research Datalink (CPRD) Lancet Public Health 2017; 2: e Time(yr) 9

10 Proportion of patients with dementia prescribed an antidementia drug CPRD=Clinical Practice Research Datalink Proportion of patients with Alzheimer s disease prescribed an antidementia drug Lancet Public Health 2017; 2: e Proportion of patients with dementia prescribed an antipsychotics CPRD=Clinical Practice Research Datalink Proportion of patients with dementia prescribed an anxiolytic, hypnotic, or antidepressant Lancet Public Health 2017; 2: e

11 European Context (OECD European Union, 2010) Prevalence of dementia million. Highest prevalence: Sweden, Italy, Switzerland, Germany. Most common causes: Alzheimer s disease (50-70%), Vascular dementia (30%). Rates increase with age: one-third of males (32.4%), half of females (48.8%) at age 95 years. Patterns of care: informal care by families and friends & formal care at home or in institutions. Global Dementia Observatory 11

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13 Biopsychosocial national dementia plan: Chilli Front. Aging Neurosci. 2017; 9:221. doi: /fnagi

14 Dementia Strategy Northern Ireland strategies DHSSPS (2010) A partnership for Care: to improve the health and well being of the people of Northern Ireland. to ensure safe and effective care services are delivered. The Northern Ireland Dementia Strategy DHSSPS (2011) Improving dementia services in Northern Ireland Prevention Assessment Treatment of risk factors Person centred care Self care Collaboration between care organisations, local government, independent and voluntary sectors 14

15 Aims and categories of dementia registries Alzheimer s & Dementia 2017; 1 17 Populations captured in existing dementia registries Registry research: quality of care People with dementia Alzheimer s & Dementia 2017;

16 Empowerment Human right WHO:Global dementia action plan seven crosscutting principles Multisectoral collaboration Equity Universal health and social care Attention to prevention, cure and care Evidence based practice 16

17 7 Areas of work The Global Plan For Dementia : Action and Target 17

18 WHO meeting in Geneva on implementation of the Global Action Plan on the Public Health Response to Dementia (GAP). The meeting included presentation of the newly launched Global Dementia Observatory (GDO) and e tool 18

19 Lancet Neurol Nov;15(12): Numbers(%) of thematic research avenues by overarching research domain Mean of the priority scores for the top 20 thematic research avenues for each of the seven overarching research domains across the 5 scoring criteria Lancet Neurol Nov;15(12):

20 Technology Assisted Care Coordination Model for Chronic Disease Better Health Outcomes Decreased Cost Increased quality Monitoring Education Feedback Caregivers Patients at home HTN, DM, COPD, CHF, Asthma, depression, PTSD Peer Leaders Education Support Feedback Pharma cy s Specialist Primary Care Providers Non VA Providers Care coordination team Support Technologies 20

21 Int J Geriatr Psychiatry. 2018; goals 30 recommendation 1. Prevent Future Cases of Dementia Through Increasing Knowledge of Risk and Protective Factors 2. Maximise the Benefits to People Living With Dementia and Their Families of Seeking and Receiving a Diagnosis of Dementia 3. Improve Quality of Life for People Affected by Dementia by Promoting Functional Capabilities and Independence While Preventing and Treating Negative Consequences of Dementia 4. Enable the Dementia Workforce to Deliver Improved Practice by Increasing Knowledge and Informing Changes in Practice and Culture 5. Optimise Quality and Inclusivity of Health and Social Care systems That Support People Affected by Dementia Antidementia Drugs 21

22 58% 45% USA 52% 73% Treatment with anti dementia Drugs among Medicare Fee for Service Part D Beneficiaries with a Prevalent or New Diagnosis of Dementia in 2009 J Am Geriatr Soc. 2016; 64(8): Modeled Association of Beneficiary characteristics with Treatment with Anti dementia Drug within 1 year of Newly Diagnosed Dementia Authorisation and Reimbursement of Alzheimer Drugs in Europe A = authorised; R = part of the reimbursement system. EUROPEAN NEUROLOGICAL DISEASE 2007;

23 Prescription and Reimbursement Criteria for Treatments of Alzheimer s Disease in Europe EUROPEAN NEUROLOGICAL DISEASE 2007;40 44 Prescription and Reimbursement Criteria for Treatments of Alzheimer s Disease in Europe EUROPEAN NEUROLOGICAL DISEASE 2007;

24 Zahirovic et al. BMC Geriatrics (2018) 18:50 N=610 Psychotropic medication: DLB Anatomical Therapeutic Chemical (ATC) Classification System Zahirovic et al. BMC Geriatrics (2018) 18:50 24

25 Antidementia Medication:DLB Zahirovic et al. BMC Geriatrics 2018; 18:50 JAMA Intern Med. 2014;174(11): d 25

26 Serge Gauthier, MD, Chair of ADI s Medical and Scientific Advisory Panel (MSAP), said: Anti dementia drugs are an important component of disease management, in many cases temporarily alleviating symptoms or slowing progression of the condition. Ceasing reimbursement will mean that families will need to shoulder the burden of cost themselves. ADI is calling for equitable and fair access to anti dementia drugs. Alongside our MSAP, a global committee of dementia experts, ADI announces that we will apply to register anti dementia drugs onto the WHO Model List of Essential Medicines. Working alongside research institutions, this process will be led by MSAP and completed by

27 การค ดเล อกยาโดยใช ระบบคะแนนช วยลดอคต ในการค ดเล อกยา 27

28 Antidementia Drugs in the National Drug lists Thailand: Alzheimer Disease รอผลมต จากคณะกรรมการประสานผล Vascular dementia มต คณะท างานฯ ชะลอการค ดเล อกยา donepezil hydrochloride ร ปแบบ tab ในข อบ งใช ภาวะสมองเส อมจากโรคหลอดเล อดสมอง (vascular dementia) เข าบ ญช ยาหล กแห งชาต จนกว าจะม ข อม ลด าน efficacy ท มากข น ท งน โรคน ย งม ว ธ ในการป องก นอย ค อ การป องก น ไม ให เป นโรคหลอดเล อดสมอง (stroke prevention) 28

29 Thank You For Your Attention 29