- Contents lists available at sciencedirect.com Journal homepage: www.elsevier.com/locate/jval A Real-World Evidence Analysis of Associations Among Costs, Quality of Life, and Disease-Severity Indicators of Alzheimer’s Disease in Thailand Khachen Kongpakwattana, BPharm, 1,2 Charungthai Dejthevaporn, MD, PhD, 3 Orapitchaya Krairit, MD, 4 Piyameth Dilokthornsakul, PharmD, PhD, 5 Devi Mohan, MD, 2 Nathorn Chaiyakunapruk, PharmD, PhD 1,6, * 1 School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; 2 Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia; 3 Division of Neurology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 4 Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5 Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; 6 College of Pharmacy, University of Utah, Salt Lake City, UT, USA. ABSTRACT Background: Although an increase in the burden of Alzheimer’s disease (AD) is evident worldwide, knowledge of costs and health-related quality of life (HRQOL) associated with AD in low- and middle-income countries is still lacking. Objectives: This study aimed to collect real-world cost and HRQOL data, and investigate their associations with multiple disease-severity indicators among AD patients in Thailand. Methods: We recruited AD patients aged $60 years accompanied by their caregivers at a university-affiliated tertiary hospital. A one-time structured interview was conducted to collect disease-severity indicators, HRQOL, and caregiving information using standardized tools. The hospital’s database was used to retrieve healthcare resource utilization occurred over 6 months preceding the interview date. Costs were annualized and stratified based on cognitive status. Generalized linear models were employed to evaluate determinants of costs and HRQOL. Results: Among 148 community-dwelling patients, average annual total societal costs of AD care were $8014 (95% confidence interval [CI]: $7295-$8844) per patient. Total costs of patients with severe stage ($9860; 95% CI: $8785-$11328) were almost twice as high as those of mild stage ($5524; 95% CI: $4649-$6593). The major cost driver was direct medical costs, particularly those incurred by AD prescriptions. Functional status was the strongest determinant for both total costs and patient’s HRQOL (P value ,.001). Conclusion: Our real-world findings suggest the distinct major cost driver that results from expensive AD treatment, emphasizing the demand of country-specific cost evidence. Increases in cognitive and functional status are significantly associated with decreases in total costs of AD care and improvement in patient’s HRQOL. Keywords: Alzheimer’s disease, costs, health-related quality of life. VALUE HEALTH. 2019; -(-):-–- Introduction Alzheimer’s disease (AD) is one of the cognitive disorders un- der the umbrella of dementia, which has been ranked first among other leading chronic diseases such as limb paralysis, stroke, and depression as the major contributors to disability and dependence in the elderly worldwide. 1 Because the number of older people is growing, the number of people living with dementia is also expanding, particularly in low- and middle-income countries (LMICs). In 2015, there were 46.8 million people living with dementia globally, and 58% of those resided in LMICs. Neverthe- less, by 2050, it is estimated that the number will soar to 131 million with 68% dwelling in LMICs. 1 The global societal costs of dementia, which are projected to reach $1 trillion US dollars (US$) or approximately 1.2% of worldwide gross domestic product by 2018, are also tremendous. 1 A series of studies that evaluates resource utilization and costs associated with a certain disease is useful to inform policy decision makers about the quantity of demand for medical, social, and financial support, which may change over time. 2 Alzheimer’s Disease International has Conflict of interest: The authors have indicated that they have no conflicts of interest with regard to the content of this article. * Address correspondence to: Nathorn Chaiyakunapruk, PharmD, PhD, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT 84112, USA. Email: nathorn.chaiyakunapruk@utah.edu 1098-3015/$36.00 - see front matter Copyright ª 2019, ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. https://doi.org/10.1016/j.jval.2019.04.1937