Skip to main content
Top
Published in: Drugs 6/2012

01-04-2012 | Systematic Review

Economic Evaluation of Treatment Options in Patients with Alzheimer’s Disease

A Systematic Review of Cost-Effectiveness Analyses

Authors: Laura Pouryamout, Judith Dams, Juergen Wasem, Richard Dodel, Dr. med. Dr. rer. pol. Anja Neumann

Published in: Drugs | Issue 6/2012

Login to get access

Abstract

Introduction: Alzheimer’s disease (AD) is common among the elderly; it is responsible for 60–80% of all dementia cases. AD is characterized by cognitive decline, behavioural and psychological symptoms, and reductions in functioning and independence. Because of its progressive neurodegenerative nature and unknown aetiology, the burden of AD becomes increasingly significant in an aging population. Estimates indicate that 35.6 million people worldwide suffered from AD in 2010. By 2030 and 2050, this figure is predicted to increase to 65.7 million and 115.4 million, respectively. Costs will also rise along with the increase in the number of people diagnosed with AD. In 2010, the world-wide costs associated with dementia were estimated to be $US604 billion.
Objective: The objective of this study was to conduct a systematic review of current publications dealing with the pharmacoeconomic factors associated with AD medications and to describe the decision-analytic models used to evaluate long-term outcomes.
Methods: A systematic literature search was performed to identify articles published between 1 January 2007 and 15 July 2010. The search was also based on a previous systematic review, which included literature up to 2007. Articles were included if they were complete and original economic evaluations of AD and if they were comparative in nature. A quality assessment of the included publications was conducted and relevant information was extracted into tables.
Results: Seven out of 2067 identified articles were included in this systematic review. Four articles evaluated treatment with donepezil, one with galantamine and two with memantine. The studies were conducted in America, Europe and Asia.
Five different groups of medications were compared. The incremental cost-effectiveness ratios (ICERs) for the group of patients treated with donepezil versus no drug treatment ranged from a dominant value to h281416.13 per quality-adjusted life-year (QALY). Patients treated with donepezil versus placebo showed ICERs with a range from a dominant value (not specified) up to h20 866.77 per QALY. Treatment with memantine in addition to donepezil versus treatment with donepezil alone showed an ICER range from a dominant value to €6818.33 per QALY. In comparison with the memantine treatment as an add-on therapy, the ICER of memantine monotherapy versus standard care (without cholinesterase inhibitors [CEIs]) ranged from a dominant value to €63 087.20 per QALY. Finally, the economic evaluation of galantamine in comparison with usual care without any AD drugs showed ICERs ranging from h1894.70 to h6953 per QALY.
Conclusion: The seven identified publications included in this review indicate that treatment with CEIs or memantine seems to be reasonable in terms of clinical effects and costs for patients with AD. Depending on different hypotheses, assumptions and variables (e.g. time horizon, discount rates, initial number of patients in different states, etc.) in the sensitivity analyses, treatment with these drugs seems to be primarily a cost-effective strategy or even a cost-saving strategy. Nevertheless, the results generally are associated with a degree of uncertainty. The comparability of the results from the different economic evaluations is limited because of the different assumptions made.
Literature
2.
go back to reference Ferri C, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366(9503): 2112–7PubMedCrossRef Ferri C, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366(9503): 2112–7PubMedCrossRef
3.
go back to reference Agüero-Torres H, Fratiglioni L, Winblad B. Natural history of Alzheimer’s disease and other dementias: review of the literature in the light of the findings from the Kungsholmen Project. Int J Geriatr Psychiatry 1998 Nov; 13(11): 755–66PubMedCrossRef Agüero-Torres H, Fratiglioni L, Winblad B. Natural history of Alzheimer’s disease and other dementias: review of the literature in the light of the findings from the Kungsholmen Project. Int J Geriatr Psychiatry 1998 Nov; 13(11): 755–66PubMedCrossRef
4.
go back to reference Jones R, McCrone P, Guilhaume C. Cost effectiveness of memantine in Alzheimer’s disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging 2004; 21(9): 607–20PubMedCrossRef Jones R, McCrone P, Guilhaume C. Cost effectiveness of memantine in Alzheimer’s disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging 2004; 21(9): 607–20PubMedCrossRef
5.
go back to reference Klafki H, Staufenbiel M, Kornhuber J, et al. Therapeutic approaches to Alzheimer’s disease. Brain 2006 Nov; 129(11): 2840–55PubMedCrossRef Klafki H, Staufenbiel M, Kornhuber J, et al. Therapeutic approaches to Alzheimer’s disease. Brain 2006 Nov; 129(11): 2840–55PubMedCrossRef
6.
go back to reference Mangialasche F, Solomon A, Winblad B, et al. Alzheimer’s disease: clinical trials and drug development. Lancet Neurol 2010 Jul; 9(7): 702–16PubMedCrossRef Mangialasche F, Solomon A, Winblad B, et al. Alzheimer’s disease: clinical trials and drug development. Lancet Neurol 2010 Jul; 9(7): 702–16PubMedCrossRef
7.
8.
go back to reference Jonsson L, Wimo A. The cost of dementia in Europe: a review of the evidence, and methodological considerations. Pharmacoeconomics 2009; 27(5): 391–403PubMedCrossRef Jonsson L, Wimo A. The cost of dementia in Europe: a review of the evidence, and methodological considerations. Pharmacoeconomics 2009; 27(5): 391–403PubMedCrossRef
9.
go back to reference Quentin W, Riedel-Heller S, Luppa M, et al. Cost-of-illness studies of dementia: a systematic review focusing on stage dependency of costs. Acta Psychiatr Scand 2010 Apr; 121(4): 243–59PubMedCrossRef Quentin W, Riedel-Heller S, Luppa M, et al. Cost-of-illness studies of dementia: a systematic review focusing on stage dependency of costs. Acta Psychiatr Scand 2010 Apr; 121(4): 243–59PubMedCrossRef
10.
go back to reference Oremus M, Aquilar S. A systematic review to assess the policy-making relevance of dementia cost-of-illness studies in the US and Canada. Pharmacoeconomics 2011 Feb; 29(2): 141–56PubMedCrossRef Oremus M, Aquilar S. A systematic review to assess the policy-making relevance of dementia cost-of-illness studies in the US and Canada. Pharmacoeconomics 2011 Feb; 29(2): 141–56PubMedCrossRef
11.
go back to reference Oremus M. Systematic review of economic evaluations of Alzheimer’s disease medications. Expert Rev Pharmacoecon Outcomes Res 2008 Jun; 8(3): 273–89PubMedCrossRef Oremus M. Systematic review of economic evaluations of Alzheimer’s disease medications. Expert Rev Pharmacoecon Outcomes Res 2008 Jun; 8(3): 273–89PubMedCrossRef
12.
go back to reference Fuh J, Wang S. Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer’s disease in Taiwan. Int J Geriatr Psychiatry 2008 Jan; 23(1): 73–8PubMedCrossRef Fuh J, Wang S. Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer’s disease in Taiwan. Int J Geriatr Psychiatry 2008 Jan; 23(1): 73–8PubMedCrossRef
13.
go back to reference Gagnon M, Rive B, Hux M, et al. Cost-effectiveness of memantine compared with standard care in moderate-to-severe Alzheimer disease in Canada. Can J Psychiatry 2007 Aug; 52(8): 519–26PubMed Gagnon M, Rive B, Hux M, et al. Cost-effectiveness of memantine compared with standard care in moderate-to-severe Alzheimer disease in Canada. Can J Psychiatry 2007 Aug; 52(8): 519–26PubMed
14.
go back to reference Getsios D, Blume S, Ishak K, et al. Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer’s disease: a UK evaluation using discrete-event simulation. Pharmacoeconomics 2010 May; 28(5): 411–27PubMedCrossRef Getsios D, Blume S, Ishak K, et al. Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer’s disease: a UK evaluation using discrete-event simulation. Pharmacoeconomics 2010 May; 28(5): 411–27PubMedCrossRef
15.
go back to reference López-Bastida J, Hart W, Garcia-Perez L, et al. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease. J Alzheimers Dis 2009; 16(2): 399–407PubMed López-Bastida J, Hart W, Garcia-Perez L, et al. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease. J Alzheimers Dis 2009; 16(2): 399–407PubMed
16.
go back to reference Suh G-H. Modeling the cost-effectiveness of galantamine for mild to moderately severe Alzheimer’s disease in Korea. Value Health 2009 Nov–Dec; 12 Suppl. 3: S49–54PubMedCrossRef Suh G-H. Modeling the cost-effectiveness of galantamine for mild to moderately severe Alzheimer’s disease in Korea. Value Health 2009 Nov–Dec; 12 Suppl. 3: S49–54PubMedCrossRef
17.
go back to reference Teipel SJ, Ewers M, Reisig V, et al. Long-term cost-effectiveness of donepezil for the treatment of Alzheimer’s disease. Eur Arch Psychiatry Clin Neurosci 2007 Sep; 257(6): 330–6PubMedCrossRef Teipel SJ, Ewers M, Reisig V, et al. Long-term cost-effectiveness of donepezil for the treatment of Alzheimer’s disease. Eur Arch Psychiatry Clin Neurosci 2007 Sep; 257(6): 330–6PubMedCrossRef
18.
go back to reference Weycker D, Taneja C, Edelsberg J, et al. Cost-effectiveness of memantine in moderate-to-severe Alzheimer’s disease patients receiving donepezil. Curr Med Res Opin 2007 May; 23(5): 1187–97PubMedCrossRef Weycker D, Taneja C, Edelsberg J, et al. Cost-effectiveness of memantine in moderate-to-severe Alzheimer’s disease patients receiving donepezil. Curr Med Res Opin 2007 May; 23(5): 1187–97PubMedCrossRef
19.
go back to reference Neumann PJ. Health utilities in Alzheimer’s disease and implications for cost-effectiveness analysis. Pharmacoeconomics 2005; 23(6): 537–41PubMedCrossRef Neumann PJ. Health utilities in Alzheimer’s disease and implications for cost-effectiveness analysis. Pharmacoeconomics 2005; 23(6): 537–41PubMedCrossRef
20.
go back to reference National Institute for Health and Clinical Excellence. Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer’s disease: review of NICE. London: NICE, 2006 National Institute for Health and Clinical Excellence. Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer’s disease: review of NICE. London: NICE, 2006
21.
go back to reference 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: 1138–45PubMedCrossRef 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: 1138–45PubMedCrossRef
22.
go back to reference Claxton K, Neumann PJ, Araki S, et al. Bayesian value-of-information analysis: an application to a policy model of Alzheimer’s disease. Int J Technol Assess Health Care 2001; 17: 38–55PubMedCrossRef Claxton K, Neumann PJ, Araki S, et al. Bayesian value-of-information analysis: an application to a policy model of Alzheimer’s disease. Int J Technol Assess Health Care 2001; 17: 38–55PubMedCrossRef
23.
go back to reference Green C, Picot J, Loveman E, et al. Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer’s disease. Pharmacoeconomics 2005; 23(12): 1271–82PubMedCrossRef Green C, Picot J, Loveman E, et al. Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer’s disease. Pharmacoeconomics 2005; 23(12): 1271–82PubMedCrossRef
24.
go back to reference Jönsson 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; 21: 1230–40PubMedCrossRef Jönsson 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; 21: 1230–40PubMedCrossRef
25.
go back to reference Drummond M, Sculpher M, Torrance G, et al. Methods for the economic evaluation of health care programs. 3rd rev. ed. New York: Oxford University Press, 2005 Drummond M, Sculpher M, Torrance G, et al. Methods for the economic evaluation of health care programs. 3rd rev. ed. New York: Oxford University Press, 2005
26.
go back to reference Gold M, Siegel J, Russell L, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996 Gold M, Siegel J, Russell L, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996
27.
go back to reference Weinstein M, Siegel J, Gold M, et al. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 1996 Oct; 276(15): 1253–8PubMedCrossRef Weinstein M, Siegel J, Gold M, et al. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 1996 Oct; 276(15): 1253–8PubMedCrossRef
28.
go back to reference Leidl R, von der Schulenburg J, Wasem J. Ansätze und Methoden der ökonomischen Evaluation-eine internationale Perspektive. Baden Baden: Nomos Verlagsgesellschaft, 1999 Leidl R, von der Schulenburg J, Wasem J. Ansätze und Methoden der ökonomischen Evaluation-eine internationale Perspektive. Baden Baden: Nomos Verlagsgesellschaft, 1999
31.
go back to reference Gustavsson A, van der Putt R, Jönsson L, et al. Economic evaluation of cholinesterase inhibitor therapy for dementia: comparison of Alzheimer’s disease and dementia with Lewy bodies. Int J Geriatr Psychiatry 2009 Oct; 24(10): 1072–8PubMedCrossRef Gustavsson A, van der Putt R, Jönsson L, et al. Economic evaluation of cholinesterase inhibitor therapy for dementia: comparison of Alzheimer’s disease and dementia with Lewy bodies. Int J Geriatr Psychiatry 2009 Oct; 24(10): 1072–8PubMedCrossRef
32.
go back to reference Kasuya M, Meguro K. Health economic effect of donepezil treatment for CDR 0.5 converters to Alzheimer’s disease as shown by the Markov model. Arch Gerontol Geriatr 2010 May–Jun; 50(3): 295–9PubMedCrossRef Kasuya M, Meguro K. Health economic effect of donepezil treatment for CDR 0.5 converters to Alzheimer’s disease as shown by the Markov model. Arch Gerontol Geriatr 2010 May–Jun; 50(3): 295–9PubMedCrossRef
33.
go back to reference Kirchbach S, Simpson K, Nietert PJ, et al. A markov model of the cost effectiveness of olanzapine treatment for agitation and psychosis in Alzheimer’s disease. Clin Drug Investig 2008; 28(5): 291–303CrossRef Kirchbach S, Simpson K, Nietert PJ, et al. A markov model of the cost effectiveness of olanzapine treatment for agitation and psychosis in Alzheimer’s disease. Clin Drug Investig 2008; 28(5): 291–303CrossRef
34.
go back to reference Wong CL, Bansback N, Lee PE, et al. Cost-effectiveness: cholinesterase inhibitors and memantine in vascular dementia. Can J Neurol Sci 2009 Nov; 36(6): 735–9PubMed Wong CL, Bansback N, Lee PE, et al. Cost-effectiveness: cholinesterase inhibitors and memantine in vascular dementia. Can J Neurol Sci 2009 Nov; 36(6): 735–9PubMed
35.
go back to reference National Institute for Health and Clinical Excellence. Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease: review of NICE technology appraisal guidance 111. London: NICE, 2011 National Institute for Health and Clinical Excellence. Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease: review of NICE technology appraisal guidance 111. London: NICE, 2011
36.
go back to reference Weyerer S. Gesundheitsberichterstattung des Bundes. Altersdemenz. Berlin: Robert Koch-Institut, 2005 Weyerer S. Gesundheitsberichterstattung des Bundes. Altersdemenz. Berlin: Robert Koch-Institut, 2005
37.
go back to reference Wolfson C, Wolfson D, Asgharian M, et al. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001 Apr; 344(15): 1111–6PubMedCrossRef Wolfson C, Wolfson D, Asgharian M, et al. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001 Apr; 344(15): 1111–6PubMedCrossRef
38.
go back to reference Weinstein M, O’Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices. Modeling studies. Value Health 2003 Jan–Feb; 6(1): 9–17PubMedCrossRef Weinstein M, O’Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices. Modeling studies. Value Health 2003 Jan–Feb; 6(1): 9–17PubMedCrossRef
39.
go back to reference Drummond M, McGuire A. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001 Drummond M, McGuire A. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001
40.
go back to reference Siebert U, Behrend C, Mühlberger N, et al. Entwicklung eines Kriterienkataloges zur Beschreibung und Bewertung ökonomischer Evaluationsstudien in Deutschland. In: Leidl R, von der Schulenburg J, Wasem J, editors. Ansätze und Methoden der ökonomischen Evaluation-eine internationale Perspektive. Baden-Baden: Nomos Verlagsgesellschaft, 1999: 156–70 Siebert U, Behrend C, Mühlberger N, et al. Entwicklung eines Kriterienkataloges zur Beschreibung und Bewertung ökonomischer Evaluationsstudien in Deutschland. In: Leidl R, von der Schulenburg J, Wasem J, editors. Ansätze und Methoden der ökonomischen Evaluation-eine internationale Perspektive. Baden-Baden: Nomos Verlagsgesellschaft, 1999: 156–70
Metadata
Title
Economic Evaluation of Treatment Options in Patients with Alzheimer’s Disease
A Systematic Review of Cost-Effectiveness Analyses
Authors
Laura Pouryamout
Judith Dams
Juergen Wasem
Richard Dodel
Dr. med. Dr. rer. pol. Anja Neumann
Publication date
01-04-2012
Publisher
Springer International Publishing
Published in
Drugs / Issue 6/2012
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.2165/11631830-000000000-00000

Other articles of this Issue 6/2012

Drugs 6/2012 Go to the issue

Adis Drug Evaluation

OnabotulinumtoxinA (BOTOX®)

Adis Drug Evaluation

Etravirine