1. Cholinesterase Inhibitors in a real-world coverage study Revised outline Introduction: measurement for drug policymakers and assessment tools for clinicians What caregivers think of cholinesterase inhibitors (KAREN KOBAYASHI) Trends in utilization and costs of services associated with introduction of drug coverage for cholinesterase inhibitors (MALCOLM MACLURE) Clinical epidemiology: Who benefits? How do we know? (LYNN BEATTIE) Alzheimer’s Drug Therapy Initiative: Seniors Medication Study (GING-YUEK ROBIN HSIUNG) The ADTI CLIMAT (Clinical Meaningfulness in Alzheimer Disease Treatment) study (CLAUDIA JACOVA) ADTI: Current view and future directions

2. MEASUREMENTS FOR DRUG POLICYMAKERS AND ASSESSMENT TOOLS FOR CLINICIANS British Columbia – Alzheimer’s disease Therapy Initiative (ADTI)

4. Disclosures (PL) Honoraria and participation in advisory board meetings (Janssen, Novartis, Pfizer) Clinical trials sponsored by BMS, Elan, Janssen, Pfizer

5. Alzheimer’s Disease Therapy Initiative July 2006 – Meeting with key stakeholders - Community members - Clinicians - Government representatives Coverage for cholinesterase inhibitors provided for B.C. residents who are in mild to moderate stages of Alzheimer’s disease Concurrently, gathering evidence on “effectiveness” of medications and the program itself

6. Alzheimer’s Disease Therapy Initiative Over the following year, development of educational and medication program BC PharmaCare launched ADTI program in October 2007 – 4-phase project, now in third & fourth phase PharmaCare providing funding for ADTI until March 2012

7. Dementia Education Strategy Sharing knowledge and experience between physicians and healthcare professionals and public Conferences, public forums, literature Workshops http://www.health.gov.bc.ca/pharmacare/adti/careg iver/cognitive.html http://www.health.gov.bc.ca/pharmacare/adti/careg iver/cognitive.html

8. Special Authority Special authority coverage Three versions of form  Initiation  Renewal/switching for lack of efficacy  Switching for tolerability http://www.healthservices.gov.bc.ca/pharme/sa/adti.html

10. Dr. Oz 1234 1 st Ave, Anywhere, BC V7X 4H5 12345 604 123-4567 123-4568

12. Renewal or Switching Due to Lack of Effect

14. Patient Assessment Four areas – cognition, function (basic and instrumental activities) and behaviour Clinicians are asked to assess the change in a patient’s ability over six months – Assigning a score of + 1, 0 or - 1 for each area Clinicians are asked to make a judgment of improvement or decline, taking into account clinical factors (OPAR) Very much, much or minimal improved, no change or minimal, much or very much worse

15. ADTI Ongoing Studies The Caregiver Study - What are the benefits, if any, of ChEI from perspective of family caregivers for patients and for themselves and how do they compare with clinical assessments of these medications? Utilization and Cost Study – Trends of ChEIs and health services use before and during ADTI, with aim of estimating cost-effectiveness Clinical Epidemiology – Who benefits from ChEI including effectiveness of switching, tolerability and treatment trajectories?

16. ADTI Studies The Senior’s Medication Study - Who benefits from continued treatment and consequences of treatment termination? The CLIMAT - How can a positive response to ChEIs be characterized on a scale of clinically meaningful change? Can its items be used in situations of clinical equipoise?