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Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model.

Abstract

INTRODUCTION

in 2007 the National Institute of Health and Clinical Excellence (NICE) restricted the use of acetylcholinesterase inhibitors and memantine.

METHODS

we conducted a health technology assessment (HTA) of the effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of AD to re-consider and up-date the evidence base used to inform the 2007 NICE decision. The systematic review of effectiveness targeted randomised controlled trials. A comprehensive search, including MEDLINE, Embase and the Cochrane Library, was conducted from January 2004 to March 2010. All key review steps were done by two reviewers. Random effects meta-analysis was conducted. The cost-effectiveness was assessed using a cohort-based model with three health states: pre-institutionalised, institutionalised and dead. The perspective was NHS and Personal Social Services and the cost year 2009.

RESULTS

confidence about the size and statistical significance of the estimates of effect of galantamine, rivastigmine and memantine improved on function and global impact in particular. Cost-effectiveness also changed. For donepezil, galantamine and rivastigmine, the incremental cost per quality-adjusted life year (QALY) in 2004 was above £50,000; in 2010 the same drugs 'dominated' best supportive care (improved clinical outcome at reduced cost). This was primarily because of changes in the modelled costs of introducing the drugs. For memantine, the cost-effectiveness also improved from a range of £37-53,000 per QALY gained to a base-case of £32,000.

CONCLUSION

there has been a change in the evidence base between 2004 and 2010 consistent with the change in NICE guidance. Further evolution in cost-effectiveness estimates is possible particularly if there are changes in drug prices.

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  • Authors+Show Affiliations

    ,

    PCMD, University of Exeter, PenTAG, Veysey Building Salmon Pool Lane, Exeter, Devon EX2 4SG, UK. christopher.hyde@pcmd.ac.uk

    , , , , , , , ,

    Source

    Age and ageing 42:1 2013 Jan pg 14-20

    MeSH

    Alzheimer Disease
    Cholinesterase Inhibitors
    Cost-Benefit Analysis
    Evidence-Based Medicine
    Humans
    Memantine
    Models, Economic
    Quality-Adjusted Life Years
    Receptors, N-Methyl-D-Aspartate
    United Kingdom

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    23179169

    Citation

    Hyde, Christopher, et al. "Evolution of the Evidence On the Effectiveness and Cost-effectiveness of Acetylcholinesterase Inhibitors and Memantine for Alzheimer's Disease: Systematic Review and Economic Model." Age and Ageing, vol. 42, no. 1, 2013, pp. 14-20.
    Hyde C, Peters J, Bond M, et al. Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model. Age Ageing. 2013;42(1):14-20.
    Hyde, C., Peters, J., Bond, M., Rogers, G., Hoyle, M., Anderson, R., ... Moxham, T. (2013). Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model. Age and Ageing, 42(1), pp. 14-20. doi:10.1093/ageing/afs165.
    Hyde C, et al. Evolution of the Evidence On the Effectiveness and Cost-effectiveness of Acetylcholinesterase Inhibitors and Memantine for Alzheimer's Disease: Systematic Review and Economic Model. Age Ageing. 2013;42(1):14-20. PubMed PMID: 23179169.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model. AU - Hyde,Christopher, AU - Peters,Jaime, AU - Bond,Mary, AU - Rogers,Gabriel, AU - Hoyle,Martin, AU - Anderson,Rob, AU - Jeffreys,Mike, AU - Davis,Sarah, AU - Thokala,Praveen, AU - Moxham,Tiffany, Y1 - 2012/11/22/ PY - 2012/11/27/entrez PY - 2012/11/28/pubmed PY - 2013/5/28/medline SP - 14 EP - 20 JF - Age and ageing JO - Age Ageing VL - 42 IS - 1 N2 - INTRODUCTION: in 2007 the National Institute of Health and Clinical Excellence (NICE) restricted the use of acetylcholinesterase inhibitors and memantine. METHODS: we conducted a health technology assessment (HTA) of the effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of AD to re-consider and up-date the evidence base used to inform the 2007 NICE decision. The systematic review of effectiveness targeted randomised controlled trials. A comprehensive search, including MEDLINE, Embase and the Cochrane Library, was conducted from January 2004 to March 2010. All key review steps were done by two reviewers. Random effects meta-analysis was conducted. The cost-effectiveness was assessed using a cohort-based model with three health states: pre-institutionalised, institutionalised and dead. The perspective was NHS and Personal Social Services and the cost year 2009. RESULTS: confidence about the size and statistical significance of the estimates of effect of galantamine, rivastigmine and memantine improved on function and global impact in particular. Cost-effectiveness also changed. For donepezil, galantamine and rivastigmine, the incremental cost per quality-adjusted life year (QALY) in 2004 was above £50,000; in 2010 the same drugs 'dominated' best supportive care (improved clinical outcome at reduced cost). This was primarily because of changes in the modelled costs of introducing the drugs. For memantine, the cost-effectiveness also improved from a range of £37-53,000 per QALY gained to a base-case of £32,000. CONCLUSION: there has been a change in the evidence base between 2004 and 2010 consistent with the change in NICE guidance. Further evolution in cost-effectiveness estimates is possible particularly if there are changes in drug prices. SN - 1468-2834 UR - https://www.unboundmedicine.com/medline/citation/23179169/Evolution_of_the_evidence_on_the_effectiveness_and_cost_effectiveness_of_acetylcholinesterase_inhibitors_and_memantine_for_Alzheimer's_disease:_systematic_review_and_economic_model_ L2 - https://academic.oup.com/ageing/article-lookup/doi/10.1093/ageing/afs165 DB - PRIME DP - Unbound Medicine ER -