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Economic evaluation of donepezil for the treatment of Alzheimer's disease in Canada.

Abstract

BACKGROUND

Donepezil is a new drug recently approved in the United States and Canada for the treatment of Alzheimer's disease (AD). We estimated the cost-effectiveness of donepezil 5 mg daily as an adjunct to usual care in the management of persons with mild-to-moderate AD defined as a Mini-Mental Health State Examination (MMSE) score in the range 10 to 26.

METHODS

Treatment effect data as MMSE change-over-baseline scores were obtained from a 30-week placebo-controlled trial of donepezil. MMSE scores beyond observed trial data were estimated using a Markov model with 10 cycles of 24 weeks based on the placebo MMSE progression observed in the trial. Data from AD subjects in the Canadian Study of Health and Aging were used to estimate costs of nursing home care, community services, medications, and caregiver time as a function of MMSE score. A clinic-based cohort study from Alberta was used to estimate the distribution of AD patients by MMSE score presenting for treatment. The effectiveness measure for the economic model was expected time (over 5 years) spent with nonsevere AD (MMSE > or = 10).

RESULTS

Over 5 years of treatment, donepezil is predicted to reduce health care costs by CA$929 per patient but increase caregiver time costs by CA$48 per patient for an overall cost saving to society of CA$882 per patient. Patients not receiving donepezil are predicted to spend 2.21 years of the 5 years in nonsevere AD compared with 2.41 years for treated patients (a gain of just over 2 months). Sensitivity analysis reveals that cost savings per patient increase if more AD patients are assumed to survive to 5 years; however, if donepezil treatment continues when patients' MMSE score falls below 10, the incremental cost is higher for treatment at CA$1554 per patient.

CONCLUSION

Based on the limited available data, our model predicts that the use of donepezil for mild-to-moderate AD in Canada is associated with lower 5-year costs and less time spent with severe AD when compared with the alternative of usual care with no donepezil therapy. As more reliable long-term data become available, these predictions should be confirmed and/or updated.

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  • Authors+Show Affiliations

    ,

    Department of Clinical Epidemiology & Biostatistics, McMaster University, St. Joseph's Hospital, Hamilton, Ontario.

    , , , , ,

    Source

    MeSH

    Aged
    Alzheimer Disease
    Canada
    Cholinesterase Inhibitors
    Cost-Benefit Analysis
    Decision Support Techniques
    Donepezil
    Humans
    Indans
    Markov Chains
    Mental Status Schedule
    Piperidines

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    10323651

    Citation

    O'Brien, B J., et al. "Economic Evaluation of Donepezil for the Treatment of Alzheimer's Disease in Canada." Journal of the American Geriatrics Society, vol. 47, no. 5, 1999, pp. 570-8.
    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;47(5):570-8.
    O'Brien, B. J., Goeree, R., Hux, M., Iskedjian, M., Blackhouse, G., Gagnon, M., & Gauthier, S. (1999). Economic evaluation of donepezil for the treatment of Alzheimer's disease in Canada. Journal of the American Geriatrics Society, 47(5), pp. 570-8.
    O'Brien BJ, et al. Economic Evaluation of Donepezil for the Treatment of Alzheimer's Disease in Canada. J Am Geriatr Soc. 1999;47(5):570-8. PubMed PMID: 10323651.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Economic evaluation of donepezil for the treatment of Alzheimer's disease in Canada. AU - O'Brien,B J, AU - Goeree,R, AU - Hux,M, AU - Iskedjian,M, AU - Blackhouse,G, AU - Gagnon,M, AU - Gauthier,S, PY - 1999/5/14/pubmed PY - 1999/5/14/medline PY - 1999/5/14/entrez SP - 570 EP - 8 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 47 IS - 5 N2 - BACKGROUND: Donepezil is a new drug recently approved in the United States and Canada for the treatment of Alzheimer's disease (AD). We estimated the cost-effectiveness of donepezil 5 mg daily as an adjunct to usual care in the management of persons with mild-to-moderate AD defined as a Mini-Mental Health State Examination (MMSE) score in the range 10 to 26. METHODS: Treatment effect data as MMSE change-over-baseline scores were obtained from a 30-week placebo-controlled trial of donepezil. MMSE scores beyond observed trial data were estimated using a Markov model with 10 cycles of 24 weeks based on the placebo MMSE progression observed in the trial. Data from AD subjects in the Canadian Study of Health and Aging were used to estimate costs of nursing home care, community services, medications, and caregiver time as a function of MMSE score. A clinic-based cohort study from Alberta was used to estimate the distribution of AD patients by MMSE score presenting for treatment. The effectiveness measure for the economic model was expected time (over 5 years) spent with nonsevere AD (MMSE > or = 10). RESULTS: Over 5 years of treatment, donepezil is predicted to reduce health care costs by CA$929 per patient but increase caregiver time costs by CA$48 per patient for an overall cost saving to society of CA$882 per patient. Patients not receiving donepezil are predicted to spend 2.21 years of the 5 years in nonsevere AD compared with 2.41 years for treated patients (a gain of just over 2 months). Sensitivity analysis reveals that cost savings per patient increase if more AD patients are assumed to survive to 5 years; however, if donepezil treatment continues when patients' MMSE score falls below 10, the incremental cost is higher for treatment at CA$1554 per patient. CONCLUSION: Based on the limited available data, our model predicts that the use of donepezil for mild-to-moderate AD in Canada is associated with lower 5-year costs and less time spent with severe AD when compared with the alternative of usual care with no donepezil therapy. As more reliable long-term data become available, these predictions should be confirmed and/or updated. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/10323651/Economic_evaluation_of_donepezil_for_the_treatment_of_Alzheimer's_disease_in_Canada_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=1999&volume=47&issue=5&spage=570 DB - PRIME DP - Unbound Medicine ER -