Comparing bladder bowel dysfunction (BBD) in children with attention deficit hyperactivity disorder (ADHD) with or without ADHD medical therapy and their initial response to BBD treatment.

Alzheimer’s disease (AD) is a devastating neurodegenerative disorder, affecting the lives of tens of millions of individuals and their families worldwide []. In Europe alone, it was estimated that 5% of the population is living with AD, a figure that is continuing to rise with the aging population [, ]. In its early stages, the disease often manifests as sporadic loss of memory and cognitive decline []. As AD progresses, the cognitive impairments become more severe, including a total loss of the patient’s behavioral abilities to function independently, drastically reducing their quality of life []. For patients with AD, timely and accurate diagnosis of AD is paramount as it facilitates appropriate treatments that may slow the progression of the disease and improve patient outcomes []. Delays in diagnosis could hold up treatment and limit treatment effectiveness, emphasizing the need for advances in AD diagnostic strategies to better support patients and their families []. Current strategies to diagnose AD involve a combination of cognitive assessments, neuroimaging techniques, and the detection of disease-specific indicators, also known as biomarkers []. The primary AD biomarkers include two specific molecules: beta-amyloid and tau [, ]. Under pathological circumstances, these molecules clump together, and with time, they can accumulate and form into beta-amyloid plaques and neurofibrillary tangles in the brain, resulting in premature death of neural cells, ultimately causing the brains of patients with AD to shrink []. The detection of these biomarkers has been increasingly important with the approval of amyloid-targeting treatments, which initiation (and eligibility) often require biomarker confirmation of amyloid pathology [, ]. However, there is currently limited empirical evidence from randomized controlled trials demonstrating that earlier diagnosis using biofluid biomarker tests could lead to improved health outcomes compared with later diagnosis []. Meanwhile, observation studies have found that AD biomarker testing was associated with decreased health care resource use, therapy optimization, and improved counselling []. There are several strategies to detect AD biomarkers. One strategy involves using neuroimaging techniques, such as computed tomography, magnetic resonance imaging, and positron emission tomography (PET), which allows the visualization of abnormal accumulation of beta-amyloid and tau in the brain [–]. While neuroimaging techniques are less invasive, they typically detect these biomarkers at later stages of AD, by which point the patient may have already been experiencing cognitive symptoms []. Another strategy is to test the concentration of beta-amyloid and tau in biofluid samples, including blood and cerebrospinal fluid (CSF) [, ]. These molecules can accumulate as early as 20 years before the onset of cognitive symptoms [], representing an opportunity for biofluid biomarker tests to diagnose AD in a timely manner [, ]. However, CSF sampling requires a lumbar puncture, an invasive procedure that can cause discomfort and add procedural costs []. In this regard, blood-based biomarker tests are less invasive, but access may be limited due to variations in healthcare resources []. Altogether, the clinical uncertainties, and the differences in invasiveness and availability elevate the importance of evaluating the economic implications of biofluid biomarker testing for diagnosing AD, as their cost-effectiveness may play a vital role in its adoption in clinical practices and translate into significant economic consequences, not only for the patients but also for the healthcare systems. Therefore, evaluating the cost-effectiveness of these tests could be of significant importance for patients and healthcare providers to make informed decisions [, ]. Economic evaluation is a key approach in this process by comparing the health benefits, such as improved quality of life and treatment effectiveness, with the costs of diagnostic procedures and follow-up care []. These evaluations help to establish whether a diagnostic strategy can be financially viable when implemented in clinical practice. However, differences in the evaluation methods and the factors considered (e.g., demographics and healthcare settings) can significantly influence the results []. The existing literature on the economic evaluation of using biofluid biomarker testing to diagnose AD is limited. One systematic review from 2014 assessed the methodological quality of economic evaluations for timely AD diagnostic strategies and found the overall quality was good, but there were insufficiencies in data identification and uncertainty analyses []. However, the review was conducted over a decade ago and did not specifically focus on diagnostic strategies through testing biofluid samples to detect AD biomarkers. Given the rapid development of biofluid biomarker testing, the economic landscape has likely shifted, needing a reassessment