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Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil.

Abstract

OBJECTIVE

The efficacy and safety of memantine in patients with moderate-to-severe Alzheimer's disease (AD) receiving stable doses of donepezil were recently demonstrated in a phase III trial. The cost-effectiveness of such therapy is unknown.

RESEARCH DESIGN AND METHODS

A microsimulation model was developed to depict AD progression over time and associated clinical and economic outcomes. AD progression was measured in terms of decline in cognitive function, as assessed by the Severe Impairment Battery (SIB). At model entry, patients were assumed to have moderate-to-severe AD, to be on stable doses of donepezil, and to begin combination therapy with memantine, or continue to receive donepezil alone; duration of therapy was assumed to be 1 year. Drug efficacy was based on data from a phase III trial. Key assumptions of the model included: (1) efficacy of study drugs would extend to 1 year; (2) measures of cognitive function could be mapped to one another, as well as to global measures of disease severity; and (3) following therapy discontinuation, cognitive function would revert immediately to natural history levels. Cost-effectiveness was assessed in terms of cost (2005 US$) per quality-adjusted life-year (QALY) gained over a lifetime (3% discount rate).

RESULTS

SIB scores were estimated to improve by 3.3 over 1 year from therapy with memantine plus donepezil (vs. donepezil alone). While pharmacotherapy costs were estimated to increase by $1250 during the year of memantine treatment, costs of formal and informal services were estimated to decrease by $1240 over this period and by $1493 (discounted present value) over a lifetime. Findings were sensitive to the assumed SIB score at therapy initiation; cost-effectiveness was better for patients with higher initial SIB scores (i.e., less severe disease).

CONCLUSION

In patients with moderate-to-severe AD already receiving donepezil, treatment with memantine results in improved clinical outcomes and reduced total costs of care.

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  • Authors+Show Affiliations

    ,

    Policy Analysis Inc., Brookline, Massachusetts 02445, USA. dweycker@pai2.com

    , , , , ,

    Source

    Current medical research and opinion 23:5 2007 May pg 1187-97

    MeSH

    Aged
    Aged, 80 and over
    Alzheimer Disease
    Clinical Trials, Phase III as Topic
    Cost-Benefit Analysis
    Donepezil
    Drug Therapy, Combination
    Female
    Humans
    Indans
    Male
    Memantine
    Models, Econometric
    Nootropic Agents
    Piperidines

    Pub Type(s)

    Evaluation Studies
    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17519086

    Citation

    Weycker, Derek, et al. "Cost-effectiveness of Memantine in Moderate-to-severe Alzheimer's Disease Patients Receiving Donepezil." Current Medical Research and Opinion, vol. 23, no. 5, 2007, pp. 1187-97.
    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;23(5):1187-97.
    Weycker, D., Taneja, C., Edelsberg, J., Erder, M. H., Schmitt, F. A., Setyawan, J., & Oster, G. (2007). Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil. Current Medical Research and Opinion, 23(5), pp. 1187-97.
    Weycker D, et al. Cost-effectiveness of Memantine in Moderate-to-severe Alzheimer's Disease Patients Receiving Donepezil. Curr Med Res Opin. 2007;23(5):1187-97. PubMed PMID: 17519086.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil. AU - Weycker,Derek, AU - Taneja,Charu, AU - Edelsberg,John, AU - Erder,M Haim, AU - Schmitt,Frederick A, AU - Setyawan,Juliana, AU - Oster,Gerry, PY - 2007/5/24/pubmed PY - 2007/7/27/medline PY - 2007/5/24/entrez SP - 1187 EP - 97 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 23 IS - 5 N2 - OBJECTIVE: The efficacy and safety of memantine in patients with moderate-to-severe Alzheimer's disease (AD) receiving stable doses of donepezil were recently demonstrated in a phase III trial. The cost-effectiveness of such therapy is unknown. RESEARCH DESIGN AND METHODS: A microsimulation model was developed to depict AD progression over time and associated clinical and economic outcomes. AD progression was measured in terms of decline in cognitive function, as assessed by the Severe Impairment Battery (SIB). At model entry, patients were assumed to have moderate-to-severe AD, to be on stable doses of donepezil, and to begin combination therapy with memantine, or continue to receive donepezil alone; duration of therapy was assumed to be 1 year. Drug efficacy was based on data from a phase III trial. Key assumptions of the model included: (1) efficacy of study drugs would extend to 1 year; (2) measures of cognitive function could be mapped to one another, as well as to global measures of disease severity; and (3) following therapy discontinuation, cognitive function would revert immediately to natural history levels. Cost-effectiveness was assessed in terms of cost (2005 US$) per quality-adjusted life-year (QALY) gained over a lifetime (3% discount rate). RESULTS: SIB scores were estimated to improve by 3.3 over 1 year from therapy with memantine plus donepezil (vs. donepezil alone). While pharmacotherapy costs were estimated to increase by $1250 during the year of memantine treatment, costs of formal and informal services were estimated to decrease by $1240 over this period and by $1493 (discounted present value) over a lifetime. Findings were sensitive to the assumed SIB score at therapy initiation; cost-effectiveness was better for patients with higher initial SIB scores (i.e., less severe disease). CONCLUSION: In patients with moderate-to-severe AD already receiving donepezil, treatment with memantine results in improved clinical outcomes and reduced total costs of care. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/17519086/Cost_effectiveness_of_memantine_in_moderate_to_severe_Alzheimer's_disease_patients_receiving_donepezil_ L2 - http://www.tandfonline.com/doi/full/10.1185/030079907X188071 DB - PRIME DP - Unbound Medicine ER -