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The Cost-Benefit of Cholinesterase Inhibitors in Mild to Moderate Dementia

A Willingness-To-Pay Approach

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Abstract

Objective: This study aimed to measure the economic value of cholinesterase inhibitors when used to treat Alzheimer’s disease using the willingness-to-pay (WTP) approach and the framework of cost-benefit analysis.

Methods and study design: A cost-benefit analysis using the WTP approach was employed. The study sample consisted of 28 nonprofessional caregivers of outpatients with mild to moderate dementia from Toronto, ON, Canada. The caregivers were presented with four scenarios. In the first scenario, scenario A, a hypothetical patient with mild dementia was stabilised with a cholinesterase inhibitor. In the second scenario, scenario A with adverse effects, the above patient (A) experienced adverse effects caused by the drug. In the third scenario, scenario B, the patient exhibited behavioural symptoms in addition to mild dementia, and both were stabilised with the drug. In the fourth scenario, scenario B with adverse effects, the above patient (B) experienced adverse effects caused by the drug. The caregivers were then asked what amount they would pay, in Canadian dollars, each year to buy the medication, assuming that they were the caregivers of the patient described. A multivariate regression analysis was performed to assess the relationship between the demographic data (including the caregiver’s yearly income) and the WTP. The average WTP was also predicted for the general population and the elderly population of Canada using data from Statistics Canada, and these values were compared with the cost of the medication.

Study perspective: Nonprofessional caregiver perspective. All monetary values are 1999 values unless otherwise specified.

Results: The mean yearly WTP was $Can4540 (95% CI 2334-6746) for scenario A, $Can3686 (95% CI 1530-5842) for scenario A with adverse effects, $Can5003 (95% CI 2661-7345) for scenario B and $Can4486 (95% CI 2222-6750) for scenario B with adverse effects. The WTP decreased when drug adverse effects were present (significantly in scenario A; p = 0.04), but did not significantly increase when behavioural symptoms were present and stabilised. In all scenarios, caregiver yearly income was the only significant predictor of WTP, in the direction expected. For all scenarios, the calculated WTPs from the regression analysis using our sample mean, the average Canadian population data and the elderly population data were all higher than the yearly cost of the cholinesterase inhibitors, with the net benefit ranging from $Canl723 to $Can4508.

Conclusions: The results of the study, from a small sample of nonprofessional caregivers, revealed that the caregivers are willing to pay more for cholinesterase inhibitors than the drugs cost, even when the adverse effects of the drugs are taken into consideration. This indicates a net benefit for cholinesterase inhibitors in the treatment of mild to moderate dementia from a consumer’s point of view.

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References

  1. Ernst RL, Hay JW. The US economic and social costs of Alzheimer’s disease revisited. Am J Public Health 1994 Aug; 84(8): 1261–4

    Article  PubMed  CAS  Google Scholar 

  2. Canadian Study of Health and Aging Working Group. Canadian Study of Health and Aging: study methods and prevalence of dementia. CMAJ 1994 Mar 15; 150(6): 899–913

    Google Scholar 

  3. Sapienza A. AD and related dementias: whose burden? Pharmaceutical News 1995; 2(1): 27–8

    Google Scholar 

  4. Eagles JM, Beattie JAG, Restall DB, et al. Relation between cognitive impairment and early death in the elderly. BMJ 1990 Jan 27; 300(6713): 239–40

    Article  PubMed  CAS  Google Scholar 

  5. Leon J, Cheng C-K, Neumann PJ. Alzheimer’s disease care: costs and potential savings. Health Aff 1998 Nov–Dec; 17(6): 206–16

    Article  CAS  Google Scholar 

  6. Hux MJ, O’Brien BJ, Iskedjian M, et al. Relation between severity of Alzheimer’s disease and costs of caring. CMAJ 1998 Sep 8; 159(5): 457–65

    PubMed  CAS  Google Scholar 

  7. Gauthier S. Advances in the pharmacotherapy of Alzheimer’s disease. CMAJ 2002 Mar 5; 166(5): 615–23

    Google Scholar 

  8. Cummings JL, Frank JC, Cherry D, et al. Guidelines for managing Alzheimer’s disease. Part I: assessment. Am Fam Physician 2002 Jun 1; 65(11): 2263–72

    PubMed  Google Scholar 

  9. Cummings JL, Frank JC, Cherry D, et al. Guidelines for managing Alzheimer’s disease. Part II: treatment. Am Fam Physician 2002 Jun 15; 65(12): 2525–34

    Google Scholar 

  10. Small GW, Rabins PV, Barry PP, et al. Diagnosis and treatment of Alzheimer’s disease and related disorders: consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatrics Society. JAMA 1997 Oct 22–29; 278(16): 1363–71

    Article  PubMed  CAS  Google Scholar 

  11. Erkinjuntti T, Kurz A, Gauthier S, et al. Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomized trial. Lancet 2002 Apr 13; 359(9314): 1283–90

    Article  PubMed  Google Scholar 

  12. McKeith I, Del Ser T, Spano P, et al. Efficacy of rivastigmine in dementia with Lewy bodies: a randomized double blind placebo controlled international study. Lancet 2000 Dec 16; 356(9247): 2031–6

    Article  PubMed  CAS  Google Scholar 

  13. Feldman H, Gauthier S, Hecker J, et al. A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease. Neurology 2001 Aug 28; 57(4): 613–20

    Article  PubMed  CAS  Google Scholar 

  14. Mohs RC, Doody RS, Morris JC, et al. A 1-year, placebocontrolled preservation of function survival study of donepezil in AD patients. Neurology 2001 Aug 14; 57(3): 481–8

    Article  PubMed  CAS  Google Scholar 

  15. Rösier M, Anand R, Cicin-Sian A, et al. Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: international randomized controlled trial. BMJ 1999 Mar 6; 318(7184): 633–8

    Google Scholar 

  16. Wilkinson D, Murray J. Galantamine: a randomized double blind, dose comparison in patients with Alzheimer’s disease. Int J Geriatr Psychiatry 2001 Sep; 16(9): 852–7

    Article  PubMed  CAS  Google Scholar 

  17. Trinh NH, Hoblyn J, Mohanty S, et al. Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer’s disease: a metaanalysis. JAMA 2003 Jan 8; 289(2): 210–6

    Article  PubMed  CAS  Google Scholar 

  18. Winblad B, Wimo A. Assessing the societal impact of acetylcholinesterase inhibitor therapies. Alzheimer Dis Assoc Disord 1999; 13Suppl. 2: s9–19

    PubMed  Google Scholar 

  19. Canadian Coordinating Office for Health Technology Assessment. Guidelines for economic evaluation of Pharmaceuticals: Canada. 2nd ed. Ottawa (ON): Canadian Coordinating Office for Health Technology Assessment (CCOHTA), 1997

  20. Bala M, Mauskopf JA, Wood LL. Willingness to pay as a measure of health benefits. Pharmacoeconomics 1999 Jan; 15(1): 9–18

    Article  PubMed  CAS  Google Scholar 

  21. Johnson FR, Fries EE, Banzhaf HS. Valuing morbidity: an integration of the willingness-to-pay and health-status index literatures. J Health Econ 1997 Dec; 16(6): 641–65

    Article  PubMed  CAS  Google Scholar 

  22. Thompson MS. Willingness to pay and accept risks to cure chronic disease. Am J Public Health 1986 Apr; 76(4): 392–6

    Article  PubMed  CAS  Google Scholar 

  23. Olsen JA, Smith RD. Theory versus practice: a review of ‘willingness-to-pay’ in health and health care. Health Econ 2001 Jan; 10(1): 39–52

    Article  PubMed  CAS  Google Scholar 

  24. Cummings JL, Mega M, Gray K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994 Dec; 44(12): 2308–14

    Article  PubMed  CAS  Google Scholar 

  25. Winblad B, Engedal K, Soininen H, et al. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology 2001 Aug 14; 57(3): 489–95

    Article  PubMed  CAS  Google Scholar 

  26. Tariot PN, Solomon PR, Morris JC, et al. A 5-month, randomized, placebo-controlled trial of galantamine in AD: the Galantamine USA-10 Study Group. Neurology 2000 Jun 27; 54(12): 2269–76

    Article  PubMed  CAS  Google Scholar 

  27. Statistics Canada. Average total income by selected family types [online]. Available from URL: http://www.statcan.ca/english/Pgdb/People/Families/famil05a.htm [Accessed 2002 Sep 23]

  28. Statistics Canada. Selected income statistics for individuals, families and households, 1991 and 1996 Censuses [online]. Available from URL: http://www.statcan.ca/english/Pgdb/People/Families/famil61b.htm [Accessed 2002 Sep 23]

  29. Ontario Ministry of Health and Long-Term Care. Ontario drug benefit formulary/comparative drug index. Ontario (ON): Ontario Ministry of Health and Long-Term Care, 2001 Mar 7

  30. O’Brien BJ, Goeree R, Hux M, et al. Economic evaluation of donepezil for the treatment of Alzheimer’s disease in Canada. J Am Geriatr Soc 1999 May; 47(5): 570–8

    PubMed  Google Scholar 

  31. Neumann PJ, Hermann RC, Kuntz KM, et al. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease. Neurology 1999 Apr 12; 52(6): 1138–45

    Article  PubMed  CAS  Google Scholar 

  32. Jonsson L, Lindgren P, Wimo A, et al. The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer’s disease: a Markov model. Clin Ther 1999 Jul; 21(7): 1230–40

    Article  PubMed  CAS  Google Scholar 

  33. Stewart A, Phillips R, Dempsey G. Pharmacotherapy for people with Alzheimer’s disease: a Markov-cycle evaluation of five years’ therapy using donepezil. Int J Geriatr Psychiatry 1998 Jul; 13(7): 445–53

    Article  PubMed  CAS  Google Scholar 

  34. Ikeda S, Yamada Y, Ikegami N. Economic evaluation of donepezil treatment for Alzheimer’s disease in Japan. Dement Geriatr Cogn Disord 2002; 13(1): 33–9

    Article  PubMed  CAS  Google Scholar 

  35. McRae T, Knopman D, Duttagupta S, et al. Donepezil delays time to nursing home placement in patients with Alzheimer’s disease. Am J Geriatr Psychiatry 2001; 9(3) Suppl. 1: 79–80

    Google Scholar 

  36. Wimo A, Winblad B, Mastey V, et al. An economic evaluation of donepezil in mild to moderate Alzheimer’s disease: results of a one-year, double-blind, randomized trial [abstract no. 282]. Neurobiol Aging 2000; 21Suppl. 1: S63

    Article  Google Scholar 

  37. Fillit HM, Gutterman EM, Brooks RL. Impact of donepezil on caregiving burden for patients with Alzheimer’s disease. Int Psychogeriatr 2000 Sep; 12(3): 389–401

    Article  PubMed  CAS  Google Scholar 

  38. Fillit H, Gutterman EM, Lewis B. Donepezil use in managed Medicare: effect on health care costs and utilization. Clin Ther 1999 Dec; 21(12): 2173–85

    Article  PubMed  CAS  Google Scholar 

  39. Cummings JL, Duttagupta S, Wade S, et al. Cost savings associated with donepezil use for Alzheimer’s disease patients in managed care. Am J Geriatr Psychiatry 2001; 9(3 Suppl. 1): 53

    Google Scholar 

  40. Hill JW, Futterman R, Mastey V, et al. The effect of donepezil therapy on health care costs in a Medicare managed care plan. Manag Care Interface 2002 Mar; 15(3): 63–70

    PubMed  Google Scholar 

  41. O’Brien BJ, Novosel S, Torrance G, et al. Assessing the economic value of a new antidepressant: a willingness-to-pay approach. Pharmacoeconomics 1995 Jul; 8(1): 34–45

    Article  PubMed  Google Scholar 

  42. Herrmann N. Recommendations for the management of behavioral and psychological symptoms of dementia. Can J Neurol Sci 2001 Feb; 28Suppl. 1: S96–107

    PubMed  Google Scholar 

  43. Davey P, Grainger D, MacMillan J, et al. Economic evaluation of insulin lispro versus neutral (regular) insulin therapy using a willingness to pay approach. Pharmacoeconomics 1998 Mar; 13(3): 347–58

    Article  PubMed  CAS  Google Scholar 

  44. Ortega A, Dranitsaris G, Puodziunas A. What are cancer patients willing to pay for epoetin alfa: a cost-benefit analysis. Cancer 1998 Dec 15; 83(12): 2588–96

    Article  PubMed  CAS  Google Scholar 

  45. Dranitsaris G, Longo CJ, Grossman LD. The economic value of a new insulin preparation, Humalog® mix 25™: measured by a willingness-to-pay approach. Pharmacoeconomics 2000 Sep; 18(3): 275–87

    Article  PubMed  CAS  Google Scholar 

  46. Doody RS, Geldmacher DS, Gordon B, et al. Open-label, multicenter, phase 3 extension study of the safety and efficacy of donepezil in patients with Alzheimer’s disease. Arch Neurol 2001 Mar; 58(3): 427–33

    Article  PubMed  CAS  Google Scholar 

  47. Farlow M, Anand R, Messina Jr J, et al. A 52-week study of the efficacy of rivastigmine in patients with mild to moderately severe Alzheimer’s disease. Eur Neurol 2000; 44(4): 236–41

    Article  PubMed  CAS  Google Scholar 

  48. Raskind MA, Peskind ER, Wessel T, et al. Galantamine in AD: a 6-month randomized, placebo-controlled trial with a 6-month extension: the Galantamine USA-1 Study Group. Neurology 2000 Jun 27; 54(12): 2261–8

    Article  PubMed  CAS  Google Scholar 

  49. Rogers SL, Doody RS, Pratt RD, et al. Long-term efficacy and safety of donepezil in the treatment of Alzheimer’s disease: final analysis of a US multicentre open-label study. Eur Neuropsychopharmacol 2000 May; 10(3): 195–203

    Article  PubMed  CAS  Google Scholar 

  50. Rogers SL, Friedhoff LT. Long-term efficacy and safety of donepezil in the treatment of Alzheimer’s disease: an interim analysis of the results of a US multicentre open label extension study. Eur Neuropsychopharmacol 1998 Feb; 8(1): 67–75

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This study was supported by a United States Pharmacopeia (USP) Information Development award (Dr Lanctôt). We are grateful to the study interviewer, Marie Kameka. Dr Lanctôt received research horonoraria and/or speaker fees and/or travel assistance from Janssen-Ortho, Pfizer, Neotherapeutics and Lundbeck. Dr Herrmann received research horonoraria and/or speaker fees and/or travel assistance from Pfizer, Janssen-Ortho, Novartis and Lundbeck. Other authors have no competing interests to declare.

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  1. Department of Psychiatry, HOPE Research Centre and Division of Clinical Pharmacology, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Rm. FG 05, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada

    Grace Wu,  Krista L. Lanctôt, Nathan Herrmann, Shehnaz Moosa & Paul I. Oh

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  1. Grace Wu
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  2. Krista L. Lanctôt
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Correspondence to Krista L. Lanctôt.

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Wu, G., Lanctôt, K.L., Herrmann, N. et al. The Cost-Benefit of Cholinesterase Inhibitors in Mild to Moderate Dementia. CNS Drugs 17, 1045–1057 (2003). https://doi.org/10.2165/00023210-200317140-00004

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