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

A Regression-Based Simulation Model

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Abstract

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.

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References

  1. Knopman D, Schneider L, Davis K, et al. Long-term tacrine (Cognex) treatment: effects on nursing home placement and mortality. Neurology 1996; 47: 166–77

    Article  PubMed  CAS  Google Scholar 

  2. Jönsson L, Lindgren P, Wimo A, et al. Costs of minimental state examination-related cognitive impairment. Pharmacoeconomics 1999; 16 (4): 409–16

    Article  PubMed  Google Scholar 

  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: 51–5

    Article  PubMed  Google Scholar 

  4. Penn P, Gray A. Estimating long term cost savings from treatment of Alzheimer’s disease: a modelling approach. Pharmacoeconomics 1999; 16 (2): 165–74

    Article  Google Scholar 

  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: 1138–45

    Article  PubMed  CAS  Google Scholar 

  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: 1604–8

    Article  PubMed  CAS  Google Scholar 

  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: 970–3

    Article  PubMed  CAS  Google Scholar 

  8. Ruitenberg A, Kalmijn S, de Ridder MAJ, et al. Natural history of Alzheimer’s disease. The Rotterdam Study. Neuroepidemiology. In press

  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: 189–98

    Article  PubMed  CAS  Google Scholar 

  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: 439–49

    Article  PubMed  CAS  Google Scholar 

  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. 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, 1998

    Google Scholar 

  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, 1997

    Google Scholar 

  14. Nationaal Ziekenhuisinstituut (NZi). Financiële statistiek 1996. Utrect: NZi, 1997. [Care/National Institute for Hospitals. Financial statistics 1996. Utrecht: NZi, 1997]

  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: 55–61

    Article  PubMed  Google Scholar 

  16. Stommel M, Collins CE, Given BA. The costs of family contributions to the care of persons with dementia. Gerontologist 1994; 34 (2): 199–205

    Article  PubMed  CAS  Google Scholar 

  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: 338–41

    Article  PubMed  CAS  Google Scholar 

  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: 914–9

    Article  CAS  Google Scholar 

  19. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969: 9; 179–86

    Article  PubMed  CAS  Google Scholar 

  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: 633–40

    Article  PubMed  Google Scholar 

  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: 985–91

    Article  CAS  Google Scholar 

  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: 445–53

    Article  Google Scholar 

  23. Ernst RL, Hay JW, Fenn C, et al. Cognitive function and the costs of Alzheimer disease. Arch Neurol 1997; 54: 687–93

    Article  PubMed  CAS  Google Scholar 

  24. Henke CJ, Burchmore MJ. The economic impact of tacrine in the treatment of Alzheimer’s disease. Clin Ther 1997; 19 (2): 330–45

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

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.

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Authors and Affiliations

  1. Institute for Medical Technology Assessment, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands

    Joseph McDonnell, W. Ken Redekop, Nicole van der Roer, Elles Goes, Jan J. V. Busschbach & Frans F. H. Rutten

  2. Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands

    Annemieke Ruitenberg & Monique M. B. Breteler

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  1. Joseph McDonnell
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  2. W. Ken Redekop
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  3. Nicole van der Roer
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  4. Elles Goes
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  5. Annemieke Ruitenberg
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  6. Jan J. V. Busschbach
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  7. Monique M. B. Breteler
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McDonnell, J., Redekop, W.K., van der Roer, N. et al. The Cost of Treatment of Alzheimer’s Disease in The Netherlands. Pharmacoeconomics 19, 379–390 (2001). https://doi.org/10.2165/00019053-200119040-00005

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