Cost-effectiveness analysis of the treatment of mild and moderate Alzheimer's disease in Brazil (original) (raw)
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Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer's disease in Taiwan
International Journal of Geriatric Psychiatry, 2008
Background Donepezil is a drug used for treatment in patients with Alzheimer's disease (AD). Information regarding the cost-effectiveness of this medication was previously rare in Asia. We used techniques of decision analysis and economic evaluation in conjunction with available local epidemiological and clinical data on costs of mild to moderate AD to assess the cost-effectiveness of donepezil in Taiwan. Methods A four-state Markov model was built to simulate the disease progression of AD patients. Local transition probabilities and costs of different stages were from the studies published earlier.
Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease
Neurology, 1999
Background: Recommendations in the UK suggest restricting treatment of Alzheimer's disease with cholinesterase inhibitors, on cost-effectiveness grounds, to patients with moderate cognitive decline. As the economic analyses that informed these recommendations have been the subject of debate, we sought to address the potential limitations of existing models and produce estimates of donepezil treatment cost effectiveness in the UK using the most recent available data and simulation techniques. Methods: A discrete-event simulation was developed that predicts progression of Alzheimer's disease through correlated changes in cognition, behavioural disturbance and function. Patient-level data from seven randomized, placebo-controlled donepezil trials and a 7-year follow-up registry provided the basis for modeling longitudinal outcomes. Individuals in the simulation were assigned unique demographic and clinical characteristics and then followed for 10 years, with severity of disease tracked on continuous scales. Patient mix and costs were developed from UK-specific literature. Analyses were run for severity subgroups to evaluate outcomes for sub-populations with disease of mild versus moderate severity from both a healthcare payer and societal perspective. All costs are reported in d, year 2007 values, and all outcomes are discounted at 3.5% per annum. Results: Over 10 years, treatment of all patients with mild to moderate disease reduces overall direct medical costs by an average of over d2300 per patient. When unpaid caregiver time is also taken into consideration, savings increase to over d4700 per patient. Compared with untreated patients, patients receiving donepezil experience a discounted gain in QALYs averaging 0.11, with their caregivers gaining, on average, 0.01 QALYs. For the subset of patients starting treatment with more severe disease, savings are more modest, averaging about d1600 and d3750 from healthcare and societal perspectives, respectively.
Cost Effectiveness Analysis of Alzheimer's Disease
Turkiye Klinikleri Journal of Health Sciences, 2020
ABS TRACT Objective: Chronic diseases, comparing to the other type of diseases, consume most of the resources in the health systems. Alzheimer's Disease (AD) is a chronic cerebral disorder and is the most common type of dementia. The purpose of this research is to analyze cost effectiveness according to stages of AD from the perspective of Social Security Institution (SSI) and the society and to determine the burden of the disease on the country's budget. Material and Methods: Using the Markov Model, three parameters were calculated in the study: lifelong cost, average survival time (ST) (year), and quality adjusted life year (QALY). Results: According to the cost-effectiveness analysis, treatment in early-stage causes additional ₺ 41.237,55 cost and provides additional 1.10 QALY comparing to the treatment in severe-stage. Likewise, treatment in moderate-stage causes an additional ₺ (-) 40.439,83 cost and provides additional 1.07 QALY comparing to the treatment in severe-stage. According to the results of the budget impact analysis made from the SSI perspective for AD, 0.66% of the total health expenditures were spent on the treatment of this disease. The social cost of AD was estimated as ₺ 14.462.457,106. Conclusion: The study was concluded that early and moderate-stage treatment of AD is cost-effective compared to severestage treatment. As a result of the study, it was revealed that the social and economic costs increased and the quality of life of the patients decreased in the progress stages of AD. The results of this study are thought to be important in terms of the assessment of the economic impact of AD in the Turkey.
Background: Previous cost-effectiveness studies of cholinesterase inhibitors have modeled Alzheimer's disease (AD) progression and treatment effects through single or global severity measures, or progression to " Full Time Care ". This analysis evaluates the cost-effectiveness of donepezil versus memantine or no treatment in Germany by considering correlated changes in cognition, behavior and function. Methods: Rates of change were modeled using trial and registry-based patient level data. A discrete event simulation projected outcomes for three identical patient groups: donepezil 10 mg, memantine 20 mg and no therapy. Patient mix, mortality and costs were developed using Germany-specific sources.
Clinical and Cost-Effectiveness of Donepezil, Rivastigmine, and Galantamine for Alzheimer's Disease
International Journal of Technology Assessment in Health Care, 2002
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 effe...
Objective: The objective is to systematically review the literature on economic evaluations of pharmacological treatments of dementia disorders. Methods: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. heterogeneity in methodological approaches, use of simulation models, target populations, study time frames, and perspectives as well as comparators used. Keeping these issues in mind, we find that Cholinesterase Inhibitors (ChEIs), and especially donepezil, are dominating no treatment (i.e. less costly and more effective) for mild to moderate AD patients. For moderate to severe AD patients memantine is cost-effective compared to memantine or ChEIs alone. However, the effect of these drugs on survival is yet not established, which could have a major impact on the cost-effectiveness of these drugs. Conclusion: Pharmaceutical treatments are cost-effective comparing to no treatment for dementia patients. However, more research is required on the long-term effectiveness of these drugs, especially on the effects of drugs on survival.
Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil
Research, Society and Development
Accelerated population aging has led to a progressive increase in dementia, particularly Alzheimer’s Disease (AD). The study’s objective was to perform a cost-utility analysis on the use of memantine in the severe stage of AD in Brazil compared to no specific pharmacological treatment from the perspective of the Brazilian Unified Health System (SUS). A Markov model was designed to simulate the progression of AD through five finite stages of health that considered cognitive function and a time horizon of five years. Progression probabilities were derived from clinical trials and population-based studies. Direct costs included hospitalization, medical consultation, use of additional medications, as well as laboratory tests. The measures for Quality Adjusted Life Year (QALY) were derived from the international literature. Costs and benefits were discounted by 5%. Compared to no specific pharmacological treatment, memantine was associated with gains in QALY and additional costs. The m...
Health Economical Aspects of Alzheimer Disease and its Treatment
Psychogeriatrics, 2001
The health economics of Alzheimer disease (AD) is in a premature state, and there is a great need for methodological improvement. The scientific database is small although rapidly expanding. There is also a great interest in the pharmacoeconomics of AD amongst the drug authorities in different countries and in the pharmaceutical companies who are engaged in AD research, illustrating that it is a hot topic. In particular, aspects of quality of life among patients and caregivers, long term treatment effects and informal care should be the focus for methodological development.