, Volume 19, Issue 4, pp 379–390 | Cite as

The Cost of Treatment of Alzheimer’s Disease in The Netherlands

A Regression-Based Simulation Model
  • Joseph McDonnell
  • W. Ken Redekop
  • Nicole van der Roer
  • Elles Goes
  • Annemieke Ruitenberg
  • Jan J. V. Busschbach
  • Monique M. B. Breteler
  • Frans F. H. Rutten
Original Research Article


Objective: To examine the potential economic impact of treatment of Alzheimer’s disease.

Design: Regression-based simulation estimation of the long term costs of Alzheimer’s disease under a number of treatment scenarios. Data from an epidemiological study conducted in Rotterdam, The Netherlands, was used to simulate disease progression. Comparison of the costs and effectiveness experienced by the patients were used to measure the impact of treatment.

Patients and intervention: 2 theoretical cohorts of patients with Alzheimer’s disease, one of which receives standard treatment, while the other receives a treatment which slows cognitive decline as measured by the Mini-Mental State Examination (MMSE).

Main outcome measures and results: Under one of the scenarios examined, the baseline cost of Alzheimer’s disease was 97 866 euro (EUR; 1996 values) per patient over 10 years’ follow-up; the cost was almost EUR100 000 under all scenarios. Life expectancy following onset was about 4.5 years and MMSE decline was approximately 2 points per year for a typical prevalent (existing) patient and almost twice as much for incident (newly diagnosed) patients (1.82 vs 3.42 points per year, respectively). Slowing the rate of cognitive decline results in a slightly increased life expectancy, with more time being spent at home and less in a nursing home. Total costs (excluding those of therapy) will decrease, but savings will be modest and may well be less than the cost of therapy. Under the same scenario, total savings were EUR1571 per patient which corresponds to an annual break-even cost of just EUR453. Decisions regarding the initiation or termination of therapy will affect both the number of patients treated and the costs and potential savings of treatment.

Conclusions: The savings made in treating Alzheimer’s disease will almost certainly be small in comparison with total costs and may well be offset by the cost of the treatment itself. Simulation models can be used to estimate the effect of therapy on the costs of care and can be useful tools in clinical decision-making and allocation of resources. These results show the need for further research into the costs and effects of treatment of Alzheimer’s disease.


Nursing Home Cognitive Decline Caregiver Burden Rotterdam Study Prevalent Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by Bayer AG, Leverkusen, Germany. We are grateful to Ms Annabelle Shakespeare and Dr Pierre-Phillippe Sagnier of Bayer AG and to 3 anonymous referees for their helpful insights and suggestions.


  1. 1.
    Knopman D, Schneider L, Davis K, et al. Long-term tacrine (Cognex) treatment: effects on nursing home placement and mortality. Neurology 1996; 47: 166–77PubMedCrossRefGoogle Scholar
  2. 2.
    Jönsson L, Lindgren P, Wimo A, et al. Costs of minimental state examination-related cognitive impairment. Pharmacoeconomics 1999; 16 (4): 409–16PubMedCrossRefGoogle Scholar
  3. 3.
    Souêtre E, Thwaites RMA, Yeardley HL. Economic impact of Alzheimer’s disease in the United Kingdom: cost of care and disease severity for non-institutionalised patients with Alzheimer’s disease. Br J Psychiatry 1999; 174: 51–5PubMedCrossRefGoogle Scholar
  4. 4.
    Penn P, Gray A. Estimating long term cost savings from treatment of Alzheimer’s disease: a modelling approach. Pharmacoeconomics 1999; 16 (2): 165–74CrossRefGoogle Scholar
  5. 5.
    Neumann PJ, Hermann RC, Kuntz KM, et al. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease. Neurology 1999; 52: 1138–45PubMedCrossRefGoogle Scholar
  6. 6.
    Breteler MMB, Claus JJ, Grobbee DE, et al. Cardiovascular disease and the distribution of cognitive function in elderly people: the Rotterdam Study. BMJ 1994; 308: 1604–8PubMedCrossRefGoogle Scholar
  7. 7.
    Ott A, Breteler MMB, van Harskamp F, et al. Prevalence of Alzheimer’s disease and vascular dementia: association with education. The Rotterdam Study. BMJ 1995; 310: 970–3PubMedCrossRefGoogle Scholar
  8. 8.
    Ruitenberg A, Kalmijn S, de Ridder MAJ, et al. Natural history of Alzheimer’s disease. The Rotterdam Study. Neuroepidemiology. In pressGoogle Scholar
  9. 9.
    Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98PubMedCrossRefGoogle Scholar
  10. 10.
    Copeland JRM, Kelleher MJ, Kellett JM, et al. A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the geriatric mental state schedule. I. Development and reliability. Psychol Med 1976; 6: 439–49PubMedCrossRefGoogle Scholar
  11. 11.
    Centraal Bureau voor de Statistiek (CBS). Statistiek van de bejaardenoorden 1995. SDU-Uitgeverij/CBS Publikaties, ‘s-Gravenhage 1997’. [Central Bureau of Statistics. Statistics on homes for the aged. Den Haag: SDU Publishers/CBS Publications, 1997]Google Scholar
  12. 12.
    Ministerie van Volksgezondheid, Welzijn en Sport (VWS). Jaaroverzicht Zorg (JOZ) 1998. Den Haag: SDU Uitgeveri, 1999. [Ministry of Public Health, Welfare and Sport. Yearly overview of care 1998. Den Haag: SDU Publishers, 1998Google Scholar
  13. 13.
    Landelijke Vereniging voor Thuiszorg/Nationaal Ziekenhuisinstituut (LVT/NZi). Jaarboek Thuoiszorg 1996. Bunnik: LVT, 1997. [National Association for Home Care/National Institute for Hospitals. Yearly overview of home care 1996. Bunnik: LVT, 1997Google Scholar
  14. 14.
    Nationaal Ziekenhuisinstituut (NZi). Financiële statistiek 1996. Utrect: NZi, 1997. [Care/National Institute for Hospitals. Financial statistics 1996. Utrecht: NZi, 1997]Google Scholar
  15. 15.
    van der Roer N, Goes ES, Blom M, et al. A model of costs for of care of demented people: living at home versus institutionalisation [in Dutch]. Tijdschr Gerontol Geriatr 2000; 31: 55–61PubMedCrossRefGoogle Scholar
  16. 16.
    Stommel M, Collins CE, Given BA. The costs of family contributions to the care of persons with dementia. Gerontologist 1994; 34 (2): 199–205PubMedCrossRefGoogle Scholar
  17. 17.
    Weinberger M, Gold DT, Divine GW, et al. Expenditures in caring for patients with dementia who live at home. Am J Public Health 1993; 83: 338–41PubMedCrossRefGoogle Scholar
  18. 18.
    Katz SFA, Moskowitz RW. Studies of illness in the aged: The Index of ADL: a standardised measure of bilogical and psychosocial function. J Am Med Assoc 1963; 185: 914–9CrossRefGoogle Scholar
  19. 19.
    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969: 9; 179–86PubMedCrossRefGoogle Scholar
  20. 20.
    Rösler M, Anand R, Cici-Sain A, et al. Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: international randomised controlled trial. BMJ 1999; 318: 633–40PubMedCrossRefGoogle Scholar
  21. 21.
    Knapp MJ, Knopman DS, Solomon PR, et al. A 30-week randomized controlled trial of high-dose tacrine in patients with Alzheimer’s disease. J Am Med Assoc 1994; 271: 985–91CrossRefGoogle Scholar
  22. 22.
    Stewart A, Phillips R, Dempsey G. Pharmacotherapy for people with Alzheimer’s disease: a Markov-cycle evaluation of five years’ therapy using donezepil. Int J Geriatr Psychiatry 1998 Jul; 1397: 445–53CrossRefGoogle Scholar
  23. 23.
    Ernst RL, Hay JW, Fenn C, et al. Cognitive function and the costs of Alzheimer disease. Arch Neurol 1997; 54: 687–93PubMedCrossRefGoogle Scholar
  24. 24.
    Henke CJ, Burchmore MJ. The economic impact of tacrine in the treatment of Alzheimer’s disease. Clin Ther 1997; 19 (2): 330–45PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  • Joseph McDonnell
    • 1
  • W. Ken Redekop
    • 1
  • Nicole van der Roer
    • 1
  • Elles Goes
    • 1
  • Annemieke Ruitenberg
    • 2
  • Jan J. V. Busschbach
    • 1
  • Monique M. B. Breteler
    • 2
  • Frans F. H. Rutten
    • 1
  1. 1.Institute for Medical Technology AssessmentErasmus UniversityRotterdamThe Netherlands
  2. 2.Department of Epidemiology and BiostatisticsErasmus Medical CenterRotterdamThe Netherlands

Personalised recommendations