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Pharmacoeconomics of Alzheimer’s disease (AD) treatment with cholinesterase inhibitors

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Abstract

Until more effective and especially disease-modifying treatments for Alzheimer’s disease (AD) are available, the therapeutic arsenal consists of cholinesterase inhibitors for mild to moderate dementia and memantine for moderate to severe dementia. Health economic data make an important contribution to the planning of healthcare services and the estimation of the cost of drug reimbursement. As such, for cholinesterase inhibitors it is claimed that the direct cost of the drug itself is eclipsed by the cost savings associated with delaying institutionalisation or delaying the time of progression into a more severe disease state. The present manuscript reviews several factors contributing to the costs of AD, gives an overview of available studies claiming the cost-effectiveness of current AD treatments, highlights strengths and weaknesses of the aforementioned studies, and discusses the impact of (early) identification and treatment of AD. It is concluded that there still is a need for long-term follow-up data from prospective cohort studies before the cost-effectiveness of cholinesterase inhibitors for AD can be confirmed.

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References

  1. Burns A, Iliffe S (2009) Alzheimer’s disease. BMJ 338:b158

    Article  PubMed  Google Scholar 

  2. Querfurth HW, Laferla FM (2010) Alzheimer’s disease. N Engl J Med 362:329–344

    Article  PubMed  CAS  Google Scholar 

  3. Scuvee-Moreau J, Kurz X, Dresse A (2002) The economic impact of dementia in Belgium: results of the National Dementia Economic Study (NADES). Acta Neurol Belg 102:104–113

    PubMed  CAS  Google Scholar 

  4. Qiu C, Kivipelto M, Von SE (2009) Epidemiology of Alzheimer’s disease: occurrence, determinants, and strategies toward intervention. Dialogues Clin Neurosci 11:111–128

    PubMed  Google Scholar 

  5. Ballard C, Gauthier S, Corbett A, Brayne C, Aarsland D, Jones E (2011) Alzheimer’s disease. Lancet 377:1019–1031

    Article  PubMed  Google Scholar 

  6. Jönsson L, Berr C (2005) Cost of dementia in Europe. Eur J Neurol 12(Suppl 1):50–53

    Article  PubMed  Google Scholar 

  7. Wimo A, Jonsson L, Gustavsson A et al (2010) The economic impact of dementia in Europe in 2008-cost estimates from the Eurocode project. Int J Geriatr Psychiatry

  8. Wimo A, Winblad B, Jonsson L (2007) An estimate of the total worldwide societal costs of dementia in 2005. Alzheimers Dement 3:81–91

    Article  PubMed  Google Scholar 

  9. Lowin A, Knapp M, McCrone P (2001) Alzheimer’s disease in the UK: comparative evidence on cost of illness and volume of health services research funding. Int J Geriatr Psychiatry 16:1143–1148

    Article  PubMed  CAS  Google Scholar 

  10. Sousa RM, Ferri CP, Acosta D et al (2009) Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey. Lancet 374:1821–1830

    Article  PubMed  Google Scholar 

  11. Wimo A, Winblad B, Jonsson L (2010) The worldwide societal costs of dementia: estimates for 2009. Alzheimers Dement 6:98–103

    Article  PubMed  Google Scholar 

  12. Jonsson L, Eriksdotter JM, Kilander L et al (2006) Determinants of costs of care for patients with Alzheimer’s disease. Int J Geriatr Psychiatry 21:449–459

    Article  PubMed  Google Scholar 

  13. Caro J, Salas M, Ward A, Getsios D, Migliaccio-Walle K, Garfield F (2004) Assessing the health and economic impact of galantamine treatment in patients with Alzheimer’s disease in the health care systems of different countries. Drugs Aging 21:677–686

    Article  PubMed  Google Scholar 

  14. World Health Organization The global burden of disease: 2004 update. Available at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Last accessed: October 2011

  15. Ballard C, Sorensen S, Sharp S (2007) Pharmacological therapy for people with Alzheimer’s disease: the balance of clinical effectiveness, ethical issues and social and healthcare costs. J Alzheimers Dis 12:53–59

    PubMed  CAS  Google Scholar 

  16. Wimo A, Winblad B, Shah SN, Chin W, Zhang R, McRae T (2004) Impact of donepezil treatment for Alzheimer’s disease on caregiver time. Curr Med Res Opin 20:1221–1225

    Article  PubMed  CAS  Google Scholar 

  17. Fagnani F, Lafuma A, Pechevis M et al (2004) Donepezil for the treatment of mild to moderate Alzheimer’s disease in France: the economic implications. Dement Geriatr Cogn Disord 17:5–13

    Article  PubMed  CAS  Google Scholar 

  18. Feldman H, Gauthier S, Hecker J et al (2004) Economic evaluation of donepezil in moderate to severe Alzheimer disease. Neurology 63:644–650

    Article  PubMed  CAS  Google Scholar 

  19. Garfield FB, Getsios D, Caro JJ, Wimo A, Winblad B (2002) Assessment of health economics in Alzheimer’s disease (AHEAD): treatment with galantamine in Sweden. Pharmacoeconomics 20:629–637

    Article  PubMed  Google Scholar 

  20. Geldmacher DS, Provenzano G, McRae T, Mastey V, Ieni JR (2003) Donepezil is associated with delayed nursing home placement in patients with Alzheimer’s disease. J Am Geriatr Soc 51:937–944

    Article  PubMed  Google Scholar 

  21. Getsios D, Blume S, Ishak KJ, Maclaine GD (2010) Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer’s disease: a UK evaluation using discrete-event simulation. Pharmacoeconomics 28:411–427

    Article  PubMed  Google Scholar 

  22. Hauber AB, Gnanasakthy A, Snyder EH, Bala MV, Richter A, Mauskopf JA (2000) Potential savings in the cost of caring for Alzheimer’s disease. Treatment with rivastigmine. Pharmacoeconomics 17:351–360

    Article  PubMed  CAS  Google Scholar 

  23. Marin D, Amaya K, Casciano R et al (2003) Impact of rivastigmine on costs and on time spent in caregiving for families of patients with Alzheimer’s disease. Int Psychogeriatr 15:385–398

    Article  PubMed  Google Scholar 

  24. Migliaccio-Walle K, Getsios D, Caro JJ, Ishak KJ, O’Brien JA, Papadopoulos G (2003) Economic evaluation of galantamine in the treatment of mild to moderate Alzheimer’s disease in the United States. Clin Ther 25:1806–1825

    Article  PubMed  Google Scholar 

  25. O’Brien BJ, Goeree R, Hux M et al (1999) Economic evaluation of donepezil for the treatment of Alzheimer’s disease in Canada. J Am Geriatr Soc 47:570–578

    PubMed  Google Scholar 

  26. Ward A, Caro JJ, Getsios D, Ishak K, O’Brien J, Bullock R (2003) Assessment of health economics in Alzheimer’s disease (AHEAD): treatment with galantamine in the UK. Int J Geriatr Psychiatry 18:740–747

    Article  PubMed  CAS  Google Scholar 

  27. Courtney C, Farrell D, Gray R et al (2004) Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomised double-blind trial. Lancet 363:2105–2115

    Article  PubMed  CAS  Google Scholar 

  28. Holmes C, Burns A, Passmore P, Forsyth D, Wilkinson D (2004) AD2000: design and conclusions. Lancet 364:1213–1214

    Article  PubMed  Google Scholar 

  29. Lopez OL, Becker JT, Wahed AS et al (2009) Long-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease. J Neurol Neurosurg Psychiatry 80:600–607

    Article  PubMed  CAS  Google Scholar 

  30. Loveman E, Green C, Kirby J et al (2006) The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer’s disease. Health Technol Assess 10:iii–xi, 1

    Google Scholar 

  31. Weycker D, Taneja C, Edelsberg J et al (2007) Cost-effectiveness of memantine in moderate-to-severe Alzheimer’s disease patients receiving donepezil. Curr Med Res Opin 23:1187–1197

    Article  PubMed  CAS  Google Scholar 

  32. Green C (2007) Modelling disease progression in Alzheimer’s disease: a review of modelling methods used for cost-effectiveness analysis. Pharmacoeconomics 25:735–750

    Article  PubMed  Google Scholar 

  33. Green C, Picot J, Loveman E, Takeda A, Kirby J, Clegg A (2005) Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer’s disease. Pharmacoeconomics 23:1271–1282

    Article  PubMed  CAS  Google Scholar 

  34. Stewart A, Phillips R, Dempsey G (1998) Pharmacotherapy for people with Alzheimer’s disease: a Markov-cycle evaluation of five years’ therapy using donepezil. Int J Geriatr Psychiatry 13:445–453

    Article  PubMed  CAS  Google Scholar 

  35. Oremus M (2008) Systematic review of economic evaluations of Alzheimer’s disease medications. Expert Rev Pharmacoecon Outcomes Res 8:273–289

    Article  PubMed  Google Scholar 

  36. Waldemar G, Phung KT, Burns A et al (2007) Access to diagnostic evaluation and treatment for dementia in Europe. Int J Geriatr Psychiatry 22:47–54

    Article  PubMed  Google Scholar 

  37. Hill J, Fillit H, Thomas SK, Chang S (2006) Functional impairment, healthcare costs and the prevalence of institutionalisation in patients with Alzheimer’s disease and other dementias. Pharmacoeconomics 24:265–280

    Article  PubMed  Google Scholar 

  38. Small GW, McDonnell DD, Brooks RL, Papadopoulos G (2002) The impact of symptom severity on the cost of Alzheimer’s disease. J Am Geriatr Soc 50:321–327

    Article  PubMed  Google Scholar 

  39. Weimer DL, Sager MA (2009) Early identification and treatment of Alzheimer’s disease: social and fiscal outcomes. Alzheimers Dement 5:215–226

    Article  PubMed  Google Scholar 

  40. Ikeda S, Yamada Y, Ikegami N (2002) Economic evaluation of donepezil treatment for Alzheimer’s disease in Japan. Dement Geriatr Cogn Disord 13:33–39

    Article  PubMed  CAS  Google Scholar 

  41. Jonsson L, Lindgren P, Wimo A, Jonsson B, Winblad B (1999) The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer’s disease: a Markov model. Clin Ther 21:1230–1240

    Article  PubMed  CAS  Google Scholar 

  42. Wimo A, Winblad B, Engedal K et al (2003) An economic evaluation of donepezil in mild to moderate Alzheimer’s disease: results of a 1-year, double-blind, randomized trial. Dement Geriatr Cogn Disord 15:44–54

    Article  PubMed  CAS  Google Scholar 

  43. Lu S, Hill J, Fillit H (2005) Impact of donepezil use in routine clinical practice on health care costs in patients with Alzheimer’s disease and related dementias enrolled in a large medicare managed care plan: a case-control study. Am J Geriatr Pharmacother 3:92–102

    Article  PubMed  Google Scholar 

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Acknowledgements

The present study was initiated and funded by Pfizer Ltd. The views expressed in this article are those of the author.

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  1. Department of Neurology, UZ Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium

    Jan Versijpt

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  1. Jan Versijpt
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Correspondence to Jan Versijpt.

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Versijpt, J. Pharmacoeconomics of Alzheimer’s disease (AD) treatment with cholinesterase inhibitors. Acta Neurol Belg 112, 141–145 (2012). https://doi.org/10.1007/s13760-012-0062-9

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  • DOI: https://doi.org/10.1007/s13760-012-0062-9

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