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Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease.

Abstract

BACKGROUND

(Acetyl-)cholinesterase (ChE) inhibitors have been approved for the treatment of mild to moderate Alzheimer's disease (AD). However, use of ChE inhibitors is limited by budget constraints and disincentives on the side of health insurances and nursing care insurances.

OBJECTIVE

To analyse under what conditions the application of the acetylcholinesterase inhibitor donepezil is favourable for the treatment of patients with AD from the perspective of health insurance and nursing care insurance companies in Germany, taking into account factors such as start and duration of treatment, duration of follow-up, drug costs, internalization of opportunity costs and varying mortality and efficacy rates.

METHODS

Transition probabilities from a Swedish study and German cost data for donepezil were merged in a Markov model to follow a cohort of patients over a period of 5-10 years. We defined a base case with 1 year treatment and follow-up over 5 years and varied treatment length, follow-up interval and cost factors in sensitivity analyses.

RESULTS

In the base case, the ChE inhibitor donepezil did not lead to cost savings but to a cost-effective outcome on side of health insurances and nursing care insurances. Early treatment of AD and internalization of opportunity costs (caring time devoted to patients) led to less costs per quality adjusted life years gained. However, results are very sensitive with respect to varying mortality and efficacy rates.

CONCLUSION

The application of donepezil may be cost-effective, but considerable uncertainties remain. Moreover, the way the reimbursement system in Germany is presently arranged does not support the application of ChE inhibitors.

Authors+Show Affiliations

Alzheimer Memorial Center and Geriatric Psychiatry Branch, Dementia and Neuroimaging Section, Department of Psychiatry, Ludwig-Maximilian University, Nussbaumstr.7, Munich, 80336, Germany. stefan.teipel@med.uni-muenchen.deNo 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

Language

eng

PubMed ID

17404699

Citation

Teipel, Stefan J., et al. "Long-term Cost-effectiveness of Donepezil for the Treatment of Alzheimer's Disease." European Archives of Psychiatry and Clinical Neuroscience, vol. 257, no. 6, 2007, pp. 330-6.
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;257(6):330-6.
Teipel, S. J., Ewers, M., Reisig, V., Schweikert, B., Hampel, H., & Happich, M. (2007). Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease. European Archives of Psychiatry and Clinical Neuroscience, 257(6), pp. 330-6.
Teipel SJ, et al. Long-term Cost-effectiveness of Donepezil for the Treatment of Alzheimer's Disease. Eur Arch Psychiatry Clin Neurosci. 2007;257(6):330-6. PubMed PMID: 17404699.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease. AU - Teipel,Stefan J, AU - Ewers,Michael, AU - Reisig,Veronika, AU - Schweikert,Bernd, AU - Hampel,Harald, AU - Happich,Michael, Y1 - 2007/04/01/ PY - 2006/06/09/received PY - 2007/01/12/accepted PY - 2007/4/4/pubmed PY - 2007/12/27/medline PY - 2007/4/4/entrez SP - 330 EP - 6 JF - European archives of psychiatry and clinical neuroscience JO - Eur Arch Psychiatry Clin Neurosci VL - 257 IS - 6 N2 - BACKGROUND: (Acetyl-)cholinesterase (ChE) inhibitors have been approved for the treatment of mild to moderate Alzheimer's disease (AD). However, use of ChE inhibitors is limited by budget constraints and disincentives on the side of health insurances and nursing care insurances. OBJECTIVE: To analyse under what conditions the application of the acetylcholinesterase inhibitor donepezil is favourable for the treatment of patients with AD from the perspective of health insurance and nursing care insurance companies in Germany, taking into account factors such as start and duration of treatment, duration of follow-up, drug costs, internalization of opportunity costs and varying mortality and efficacy rates. METHODS: Transition probabilities from a Swedish study and German cost data for donepezil were merged in a Markov model to follow a cohort of patients over a period of 5-10 years. We defined a base case with 1 year treatment and follow-up over 5 years and varied treatment length, follow-up interval and cost factors in sensitivity analyses. RESULTS: In the base case, the ChE inhibitor donepezil did not lead to cost savings but to a cost-effective outcome on side of health insurances and nursing care insurances. Early treatment of AD and internalization of opportunity costs (caring time devoted to patients) led to less costs per quality adjusted life years gained. However, results are very sensitive with respect to varying mortality and efficacy rates. CONCLUSION: The application of donepezil may be cost-effective, but considerable uncertainties remain. Moreover, the way the reimbursement system in Germany is presently arranged does not support the application of ChE inhibitors. SN - 0940-1334 UR - https://www.unboundmedicine.com/medline/citation/17404699/Long_term_cost_effectiveness_of_donepezil_for_the_treatment_of_Alzheimer's_disease_ L2 - https://dx.doi.org/10.1007/s00406-007-0727-1 DB - PRIME DP - Unbound Medicine ER -