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Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease.

Abstract

OBJECTIVE

To demonstrate the use of cost-effectiveness analysis to assess the economic impact of donepezil in the treatment of mild or moderate AD.

BACKGROUND

Cost-effectiveness analyses show the relationship between resources used (costs) and health benefits achieved (effects) for an intervention compared with an alternative strategy.

METHODS

We developed a model to estimate the incremental cost-effectiveness of donepezil compared with no treatment. We determined costs per quality-adjusted life-years gained, a measurement that enhances the comparability of diverse studies. The model projects the progression of AD patients into more severe disease stages and into nursing homes. Data from a randomized clinical trial of donepezil were used to assess the drug's impact on the 6-week probabilities of progression. Data on the costs and health-related quality of life associated with different disease stages and settings were taken from published estimates and our companion cross-sectional study, respectively.

RESULTS

Donepezil costs are partially offset by a reduction in the costs of care due to enhancement in cognitive functioning and the delay to more costly disease stages and settings. The magnitude of this cost offset and of the effect of donepezil on health-related quality of life depends on the model's assumptions about the duration of the drug effect, where controlled data are lacking. If the drug effect exceeds 2 years, the model predicts that for mild AD the drug would pay for itself in terms of cost offsets.

CONCLUSIONS

The results of the cost-effectiveness model presented here suggest that donepezil may be cost-effective but additional controlled data on long-term drug efficacy are needed.

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  • Authors+Show Affiliations

    ,

    Program on the Economic Evaluation of Medical Technology, Center for Risk Analysis, Harvard School of Public Health, Boston, MA 02115, USA. pneumann@hsph.harvard.edu

    , , , , , , , ,

    Source

    Neurology 52:6 1999 Apr 12 pg 1138-45

    MeSH

    Alzheimer Disease
    Cholinesterase Inhibitors
    Cost-Benefit Analysis
    Costs and Cost Analysis
    Disease Progression
    Donepezil
    Humans
    Indans
    Piperidines
    Quality of Life

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    10214734

    Citation

    Neumann, P J., et al. "Cost-effectiveness of Donepezil in the Treatment of Mild or Moderate Alzheimer's Disease." Neurology, vol. 52, no. 6, 1999, pp. 1138-45.
    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(6):1138-45.
    Neumann, P. J., Hermann, R. C., Kuntz, K. M., Araki, S. S., Duff, S. B., Leon, J., ... Weinstein, M. C. (1999). Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease. Neurology, 52(6), pp. 1138-45.
    Neumann PJ, et al. Cost-effectiveness of Donepezil in the Treatment of Mild or Moderate Alzheimer's Disease. Neurology. 1999 Apr 12;52(6):1138-45. PubMed PMID: 10214734.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease. AU - Neumann,P J, AU - Hermann,R C, AU - Kuntz,K M, AU - Araki,S S, AU - Duff,S B, AU - Leon,J, AU - Berenbaum,P A, AU - Goldman,P A, AU - Williams,L W, AU - Weinstein,M C, PY - 1999/4/24/pubmed PY - 1999/4/24/medline PY - 1999/4/24/entrez SP - 1138 EP - 45 JF - Neurology JO - Neurology VL - 52 IS - 6 N2 - OBJECTIVE: To demonstrate the use of cost-effectiveness analysis to assess the economic impact of donepezil in the treatment of mild or moderate AD. BACKGROUND: Cost-effectiveness analyses show the relationship between resources used (costs) and health benefits achieved (effects) for an intervention compared with an alternative strategy. METHODS: We developed a model to estimate the incremental cost-effectiveness of donepezil compared with no treatment. We determined costs per quality-adjusted life-years gained, a measurement that enhances the comparability of diverse studies. The model projects the progression of AD patients into more severe disease stages and into nursing homes. Data from a randomized clinical trial of donepezil were used to assess the drug's impact on the 6-week probabilities of progression. Data on the costs and health-related quality of life associated with different disease stages and settings were taken from published estimates and our companion cross-sectional study, respectively. RESULTS: Donepezil costs are partially offset by a reduction in the costs of care due to enhancement in cognitive functioning and the delay to more costly disease stages and settings. The magnitude of this cost offset and of the effect of donepezil on health-related quality of life depends on the model's assumptions about the duration of the drug effect, where controlled data are lacking. If the drug effect exceeds 2 years, the model predicts that for mild AD the drug would pay for itself in terms of cost offsets. CONCLUSIONS: The results of the cost-effectiveness model presented here suggest that donepezil may be cost-effective but additional controlled data on long-term drug efficacy are needed. SN - 0028-3878 UR - https://www.unboundmedicine.com/medline/citation/10214734/Cost_effectiveness_of_donepezil_in_the_treatment_of_mild_or_moderate_Alzheimer's_disease_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=10214734 DB - PRIME DP - Unbound Medicine ER -