Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease

Abstract

The results of the cost-effectiveness model presented here suggest that donepezil may be cost-effective but additional controlled data on long-term drug efficacy are needed.

The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease

“…An assessment of the cost-effectiveness models submitted within industry submissions to NICE is provided, using a framework presented by Phillips and colleagues, 109 who have synthesised the literature on the evaluation of decision analytic models in a health technology assessment context to present guidelines for best practice. Table 48 provides a simple summary of the study characteristics for the nine published economic evaluations reporting on the cost-effectiveness of donepezil versus usual care, 43,56,81,82,[84][85][86][87]89 together with summary detail on two published abstracts. 83,88 The abstracts by Lanctôt and colleagues 83 and Sobolewski and colleagues 88 provide limited information and are not discussed further in this report.…”

“…Studies represent country-specific analyses for the UK (three studies), Sweden (two studies), Canada (two studies), USA, Japan, Poland and France. Table 48 reports the 'headline' finding for each study; all studies except the AD2000 study 43 reported drug efficacy either in terms of a delay in disease progression, 56,81,82,[84][85][86]88 qualityadjusted life-year (QALY) gains 83,87 or as reduced time in need of full-time care. 89 In five studies, donepezil treatment was described as cost saving, [83][84][85]87,89 although all of these studies are from an unclear or societal perspective, whereas in other studies, treatment was described as cost neutral, 82 cost incurring 43,86,88 or cost saving from a societal perspective only (i.e.…”

“…One product-specific systematic review was identified 105 to inform on the cost-effectiveness of donepezil; it included three published economic studies 82,85,86 and one abstract. 83 These published studies are discussed in the review below.…”

“…Most economic evaluations of donepezil (six of the nine published studies 82,[84][85][86][87]89 ) have used a state transition model (Markov model) to simulate disease progression in their estimation of the costeffectiveness of donepezil. The models are summarised in the following section.…”

“…All approaches modelled disease progression for a specified cohort of AD patients across different levels of disease severity (including an ongoing risk of death). Three studies used MMSE scores to define either four or five levels of AD severity, 82,84,85 two studies used CDR scores to define three levels of disease severity 86,87 and one study 89 was developed using the continuous nature of the MMSE scoring system. Progression of disease was modelled using transition probabilities between each model cycle to estimate the likelihood that a patient moves from one level of disease severity to another, with an ongoing risk of death over time.…”