Cost-effectiveness of pharmacological therapies for people with Alzheimer’s disease and other dementias: a systematic review and meta-analysis

Abstract

Objectives This study aims to synthesize the empirical economic evidence of pharmaceutical therapies for people with dementia. Study design Systematic review and meta-analysis. Literature evaluating the costs and effects of drug therapies for dementia was indexed until December 2021. Quality of study was assessed using the Cochrane Risk of Bias Tool and Consensus on Health Economic Criteria list. Cost data were standardized to 2020 US dollars and analyzed from healthcare service and societal perspectives. Random-effects models were used to synthesize economic and clinical data, based on mean differences (MDs) and standardized MDs. Results Ten unique studies were identified from 11,771 records. Acetylcholinesterase inhibitors (AChEIs) and memantine improved dementia-related symptoms, alongside nonsignificant savings in societal cost (AChEIs: MD-2002 [− 4944 ~ 939]; memantine: MD-6322 [− 14355 ~ 1711]). Despite decreases in cost, antidepressants of mirtazapine and sertraline and second-generation antipsychotics were limited by their significant side effects on patients’ cognitive and activity functions. Subgroup analysis indicated that the impacts of AChEIs on cost were affected by different analytical perspectives, follow-up periods, and participant age. Conclusions AChEIs and memantine are cost-effective with improvements in dementia-related symptoms and trends of cost-savings. More empirical evidence with non-industrial sponsorships and rigorous design in different settings is warranted.

The effects of herbal medicine (Jujadokseo-hwan) on quality of life in patients with mild cognitive impairment: Cost-effectiveness analysis alongside randomized controlled trial

“…Many economic evaluations on pharmacotherapy in patients with cognitive deficits have compared a treatment of interest with placebo or no treatment control group. 70 , 71 , 72 , 73 , 74 , 75 In future, further research is needed to compare the QoL and cost of JDH with other Korean Medicine, CAM intervention, and Western medicine treatment as well.…”

Economics and dementia: Challenges and responses

“…There is also evidence from a complex trial which shows that continued treatment with donepezil for people with moderate-to-severe Alzheimer's disease is highly cost-effective in achieving cognitive, functioning and QALY outcomes (Knapp et al, 2017). A recent systematic review and meta-analysis of ten studies of pharmacological therapies concluded that acetylcholinesterase inhibitors and memantine are cost-effective and may be cost-saving (Huo et al, 2022), but cautioned that more rigourous evidence from studies without industrial support is needed.…”

“…Despite the important roles of economic evidence, their use in decision-making remains limited. We outline below some examples to illustrate – as noted in several recent systematic reviews and meta-analyses (Huo et al, 2021a, 2021b, 2022; Walsh et al, 2022) – the current lack of economic evidence to support informed decisions.…”

Implications of Adverse Outcomes Associated with Antipsychotics in Older Patients with Dementia: A 2011–2022 Update

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