Grant: CIHR Fellowship

The number of Canadians diagnosed with Alzheimer's disease is expected to double in the next two decades. At present there is no cure for this chronic progressive neurodegenerative disease. Many take cholinesterase inhibitors (ChEI) early on to slow disease progression and manage symptoms related to loss of cognition and function. Yet the effectiveness of the drug is debated. In British Columbia, researchers are gathering and evaluating evidence to inform pharmaceutical policy for ChEI coverage as part of a 'coverage with evidence' policy trial. When the trial ends in 2012, policymakers will decide whether to continue funding ChEI under the provincial drug plan and if so the shape policy continuation will take based on clinical evidence of drug benefit and cost-effectiveness. Three years into the trial, evidence suggests that almost half of patients are initially assessed as having little or no benefit from the drug. Subjective reports from patients and their caregivers suggest otherwise. Most claim there has been qualitative benefit despite quantitative evidence to the contrary. Evidence of effectiveness is equivocal. The proposed mixed methods research will interview the decision makers (policymakers and physicians) and the people whom drug coverage decisions impact upon (patients and caregivers) to better understand the paradox of proven 'benefit' in assessment-based drug coverage. It will also examine the criteria for classifying patients as proven to 'benefit' in order to fill a significant gap in the literature about the social and health profiles of these patients. Results will inform the policy process by highlighting the need to measure drug effectiveness in terms that matter to patients and families, while at the same time preserving policymakers' need for assessment-based drug coverage. This knowledge can be translated into clinical practice across Canada as the criteria for ChEI drug coverage in BC could potentially be used in other provinces.