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Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for Alzheimer's disease. A systematic review.
Int J Technol Assess Health Care 2002; 18(3):497-507IJ

Abstract

OBJECTIVES

Systematic review of the clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for people suffering from Alzheimer's disease.

METHODS

Sixteen electronic databases (including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information. Randomized controlled trials (RCTs) and economic studies were selected. Clinical effectiveness was assessed on measurement scales assessing progression of Alzheimer's disease on the person's global health, cognition, functional ability, behavior and mood, and quality of life. Cost-effectiveness was presented as incremental cost per year spent in a nonsevere state (by Mini Mental Health State Examination) or quality-adjusted life-year.

RESULTS

Twelve of 15 RCTs included were judged to be of good quality. Although donepezil had beneficial effects in Alzheimer's patients on global health and cognition, rivastigmine on global health, and galantamine on global health, cognition, and functional scales, these improvements were small and may not be clinically significant. Measures of quality of life and behavior and mood were rarely assessed. Adverse effects were usually mild and transient. Cost-effectiveness base case estimates ranged from 2,415 Pounds savings to 49,476 Pounds additional cost (1997 prices) per unit of effect for donepezil and a small savings for rivastigmine. Estimates were not considered robust or generalizable.

CONCLUSIONS

Donepezil, rivastigmine, and galantamine appear to have some clinical effect for people with Alzheimer's disease, although the extent to which these translate into real differences in everyday life remains unclear. Due to the nature of current economic studies, cost-effectiveness remains uncertain and the impact on different care sectors has been inadequately investigated. Further research is needed to establish the actual benefits of acetylcholinesterase inhibitors (AChEls) for people with Alzheimer's disease and their caregivers, the relationship of these changes to clinical management, and careful prospective evaluation of resource and budgetary consequences.

Authors+Show Affiliations

University of Southampton.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

12391943

Citation

Clegg, Andrew, et al. "Clinical and Cost-effectiveness of Donepezil, Rivastigmine, and Galantamine for Alzheimer's Disease. a Systematic Review." International Journal of Technology Assessment in Health Care, vol. 18, no. 3, 2002, pp. 497-507.
Clegg A, Bryant J, Nicholson T, et al. Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for Alzheimer's disease. A systematic review. Int J Technol Assess Health Care. 2002;18(3):497-507.
Clegg, A., Bryant, J., Nicholson, T., McIntyre, L., De Broe, S., Gerard, K., & Waugh, N. (2002). Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for Alzheimer's disease. A systematic review. International Journal of Technology Assessment in Health Care, 18(3), pp. 497-507.
Clegg A, et al. Clinical and Cost-effectiveness of Donepezil, Rivastigmine, and Galantamine for Alzheimer's Disease. a Systematic Review. Int J Technol Assess Health Care. 2002;18(3):497-507. PubMed PMID: 12391943.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for Alzheimer's disease. A systematic review. AU - Clegg,Andrew, AU - Bryant,Jackie, AU - Nicholson,Tricia, AU - McIntyre,Linda, AU - De Broe,Sofie, AU - Gerard,Karen, AU - Waugh,Norman, PY - 2002/10/24/pubmed PY - 2002/11/26/medline PY - 2002/10/24/entrez SP - 497 EP - 507 JF - International journal of technology assessment in health care JO - Int J Technol Assess Health Care VL - 18 IS - 3 N2 - OBJECTIVES: Systematic review of the clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for people suffering from Alzheimer's disease. METHODS: Sixteen electronic databases (including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information. Randomized controlled trials (RCTs) and economic studies were selected. Clinical effectiveness was assessed on measurement scales assessing progression of Alzheimer's disease on the person's global health, cognition, functional ability, behavior and mood, and quality of life. Cost-effectiveness was presented as incremental cost per year spent in a nonsevere state (by Mini Mental Health State Examination) or quality-adjusted life-year. RESULTS: Twelve of 15 RCTs included were judged to be of good quality. Although donepezil had beneficial effects in Alzheimer's patients on global health and cognition, rivastigmine on global health, and galantamine on global health, cognition, and functional scales, these improvements were small and may not be clinically significant. Measures of quality of life and behavior and mood were rarely assessed. Adverse effects were usually mild and transient. Cost-effectiveness base case estimates ranged from 2,415 Pounds savings to 49,476 Pounds additional cost (1997 prices) per unit of effect for donepezil and a small savings for rivastigmine. Estimates were not considered robust or generalizable. CONCLUSIONS: Donepezil, rivastigmine, and galantamine appear to have some clinical effect for people with Alzheimer's disease, although the extent to which these translate into real differences in everyday life remains unclear. Due to the nature of current economic studies, cost-effectiveness remains uncertain and the impact on different care sectors has been inadequately investigated. Further research is needed to establish the actual benefits of acetylcholinesterase inhibitors (AChEls) for people with Alzheimer's disease and their caregivers, the relationship of these changes to clinical management, and careful prospective evaluation of resource and budgetary consequences. SN - 0266-4623 UR - https://www.unboundmedicine.com/medline/citation/12391943/Clinical_and_cost_effectiveness_of_donepezil_rivastigmine_and_galantamine_for_Alzheimer's_disease__A_systematic_review_ L2 - https://medlineplus.gov/alzheimersdisease.html DB - PRIME DP - Unbound Medicine ER -