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Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US.
J Med Econ 2015; 18(11):930-43JM

Abstract

OBJECTIVE

This study evaluates the cost-effectiveness of memantine extended release (ER) as an add-on therapy to acetylcholinesterase inhibitor (AChEI) [combination therapy] for treatment of patients with moderate-to-severe Alzheimer's disease (AD) from both a healthcare payer and a societal perspective over 3 years when compared to AChEI monotherapy in the US.

METHODS

A phase III trial evaluated the efficacy and safety of memantine ER for treatment of AD patients taking an AChEI. The analysis assessed the long-term costs and health outcomes using an individual patient simulation in which AD progression is modeled in terms of cognition, behavior, and functioning changes. Input parameters are based on patient-level trial data, published literature, and publicly available data sources. Changes in anti-psychotic medication use are incorporated based on a published retrospective cohort study. Costs include drug acquisition and monitoring, total AD-related medical care, and informal care associated with caregiver time. Incremental cost-utility ratio (ICUR), life years, care time for caregiver, time in community and institution, time on anti-psychotics, time by disease severity, and time without severe symptoms are reported. Costs and health outcomes are discounted at 3% per annum.

RESULTS

Considering a societal perspective over 3 years, this analysis shows that memantine ER combined with an AChEI provides better clinical outcomes and lower costs than AChEI monotherapy. Discounted average savings were estimated at $18,355 and $20,947 per patient and quality-adjusted life-years (QALYs) increased by an average of 0.12 and 0.13 from a societal and healthcare payer perspective, respectively. Patients on combination therapy spent an average of 4 months longer living at home and spend less time in moderate-severe and severe stages of the disease.

CONCLUSION

Combination therapy for patients with moderate-to-severe AD is a cost-effective treatment compared to AChEI monotherapy in the US.

Authors+Show Affiliations

a a Evidera , Montreal , QC , Canada.b b Evidera , Lexington , MA , USA.c c AstraZeneca , Gaithersburg , MD , USA.b b Evidera , Lexington , MA , USA.a a Evidera , Montreal , QC , Canada.b b Evidera , Lexington , MA , USA.d d Forest Research Institute, LLC, an affiliate of Actavis, Inc. , Jersey City , NJ , USA.

Pub Type(s)

Clinical Trial, Phase III
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26086535

Citation

Saint-Laurent Thibault, Catherine, et al. "Cost-utility Analysis of Memantine Extended Release Added to Cholinesterase Inhibitors Compared to Cholinesterase Inhibitor Monotherapy for the Treatment of Moderate-to-severe Dementia of the Alzheimer's Type in the US." Journal of Medical Economics, vol. 18, no. 11, 2015, pp. 930-43.
Saint-Laurent Thibault C, Özer Stillman I, Chen S, et al. Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US. J Med Econ. 2015;18(11):930-43.
Saint-Laurent Thibault, C., Özer Stillman, I., Chen, S., Getsios, D., Proskorovsky, I., Hernandez, L., & Dixit, S. (2015). Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US. Journal of Medical Economics, 18(11), pp. 930-43. doi:10.3111/13696998.2015.1063501.
Saint-Laurent Thibault C, et al. Cost-utility Analysis of Memantine Extended Release Added to Cholinesterase Inhibitors Compared to Cholinesterase Inhibitor Monotherapy for the Treatment of Moderate-to-severe Dementia of the Alzheimer's Type in the US. J Med Econ. 2015;18(11):930-43. PubMed PMID: 26086535.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US. AU - Saint-Laurent Thibault,Catherine, AU - Özer Stillman,Ipek, AU - Chen,Stephanie, AU - Getsios,Denis, AU - Proskorovsky,Irina, AU - Hernandez,Luis, AU - Dixit,Shailja, Y1 - 2015/08/26/ PY - 2015/6/19/entrez PY - 2015/6/19/pubmed PY - 2016/8/9/medline KW - Acetylcholinesterase inhibitors KW - Alzheimer’s disease KW - Cost KW - Cost-benefit analysis KW - Dementia KW - Effectiveness KW - Memantine SP - 930 EP - 43 JF - Journal of medical economics JO - J Med Econ VL - 18 IS - 11 N2 - OBJECTIVE: This study evaluates the cost-effectiveness of memantine extended release (ER) as an add-on therapy to acetylcholinesterase inhibitor (AChEI) [combination therapy] for treatment of patients with moderate-to-severe Alzheimer's disease (AD) from both a healthcare payer and a societal perspective over 3 years when compared to AChEI monotherapy in the US. METHODS: A phase III trial evaluated the efficacy and safety of memantine ER for treatment of AD patients taking an AChEI. The analysis assessed the long-term costs and health outcomes using an individual patient simulation in which AD progression is modeled in terms of cognition, behavior, and functioning changes. Input parameters are based on patient-level trial data, published literature, and publicly available data sources. Changes in anti-psychotic medication use are incorporated based on a published retrospective cohort study. Costs include drug acquisition and monitoring, total AD-related medical care, and informal care associated with caregiver time. Incremental cost-utility ratio (ICUR), life years, care time for caregiver, time in community and institution, time on anti-psychotics, time by disease severity, and time without severe symptoms are reported. Costs and health outcomes are discounted at 3% per annum. RESULTS: Considering a societal perspective over 3 years, this analysis shows that memantine ER combined with an AChEI provides better clinical outcomes and lower costs than AChEI monotherapy. Discounted average savings were estimated at $18,355 and $20,947 per patient and quality-adjusted life-years (QALYs) increased by an average of 0.12 and 0.13 from a societal and healthcare payer perspective, respectively. Patients on combination therapy spent an average of 4 months longer living at home and spend less time in moderate-severe and severe stages of the disease. CONCLUSION: Combination therapy for patients with moderate-to-severe AD is a cost-effective treatment compared to AChEI monotherapy in the US. SN - 1941-837X UR - https://www.unboundmedicine.com/medline/citation/26086535/Cost_utility_analysis_of_memantine_extended_release_added_to_cholinesterase_inhibitors_compared_to_cholinesterase_inhibitor_monotherapy_for_the_treatment_of_moderate_to_severe_dementia_of_the_Alzheimer's_type_in_the_US_ L2 - http://www.tandfonline.com/doi/full/10.3111/13696998.2015.1063501 DB - PRIME DP - Unbound Medicine ER -