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

Thibault, Catherine Saint-Laurent; Stillman, Ipek Özer; Chen, Stephanie; Getsios, Denis; Proskorovsky, Irina; Hernández, Luis; Dixit, Shailja

doi:10.3111/13696998.2015.1063501

Cited by 13 publications

(16 citation statements)

References 27 publications

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“…Ten studies were made using data from the United Kingdom [ 41 , 43 , 47 , 48 , 51 , 55 , 57 , 59 , 60 ], six from the United States [ 40 , 46 , 56 , 64 – 66 ], two from Spain [ 45 , 51 ], and another two from France [ 42 , 49 ]. Other studies used data from Denmark [ 50 ], Switzerland [ 52 ], Germany [ 53 ], Norway [ 54 ], Canada [ 58 ], The Netherlands [ 62 ], and Taiwan [ 63 ].…”

Section: Resultsmentioning

confidence: 99%

How relevant are social costs in economic evaluations? The case of Alzheimer’s disease

et al. 2019

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Background The main objective of this study was to analyse how the inclusion (exclusion) of social costs can alter the results and conclusions of economic evaluations in the field of Alzheimer’s disease interventions. Methods We designed a systematic review that included economic evaluations in Alzheimer’s disease. The search strategy was launched in 2000 and ran until November 2018. The inclusion criteria were: being an original study published in a scientific journal, being an economic evaluation of any intervention related to Alzheimer’s disease, including social costs (informal care costs and/or productivity losses), being written in English, using QALYs as an outcome for the incremental cost–utility analysis, and separating the results according to the perspective applied. Results It was finally included 27 studies and 55 economic evaluations. Around 11% of economic evaluations changed their main conclusions. More precisely, three of them concluded that the new intervention became cost-effective when the societal perspective was considered, whereas when using just the health care payer perspective, the new intervention did not result in a cost–utility ratio below the threshold considered. Nevertheless, the inclusion of social cost can also influence the results, as 37% of the economic evaluations included became the dominant strategy after including social costs when they were already cost-effective in the health care perspective. Conclusions Social costs can substantially modify the results of the economic evaluations. Therefore, taking into account social costs in diseases such as Alzheimer’s can be a key element in making decisions about public financing and pricing of health interventions.

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Section: Resultsmentioning

confidence: 99%

How relevant are social costs in economic evaluations? The case of Alzheimer’s disease

et al. 2019

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“…In our review, AD/dementia interventions tend to alleviate caregiver burden rather than increasing caregiver involvement. Some examples include reducing symptom severity of the patient and delaying progression to more advanced disease stages, both of which can decrease caregiving time [33,36,61].…”

Section: Discussionmentioning

confidence: 99%

Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer’s Disease Interventions

et al. 2019

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Background and objective Alzheimer's disease or dementia can impose a significant burden on family and other informal caregivers. This study investigated how the inclusion of family/informal caregiver spillover effects in a cost-utility analysis may influence the reported value of Alzheimer's disease/dementia interventions. Methods We used PubMed to identify Alzheimer's disease or dementia cost-utility analyses published from 1 January, 2000 to 31 March, 2018. We reviewed and abstracted information from each study using a two-reader consensus process. We investigated the frequency and methods in which family/caregiver spillover costs and health effects were incorporated into cost-utility analyses, and examined how their inclusion may influence the reported incremental cost-effectiveness ratios. Results Of 63 Alzheimer's disease/dementia cost-utility analyses meeting inclusion criteria, 44 (70%) considered at least some family/caregiver spillover costs or health effects. Thirty-two studies incorporated spillover costs only, two incorporated spillover health effects only, and ten incorporated both. The most common approach for accounting for spillover was adding informal caregiving time costs to patient costs (n = 36) and adding informal caregiver qualityadjusted life-years to patient values (n = 7). In a subset of 33 incremental cost-effectiveness ratio pairs from 19 studies, incorporating spillover outcomes made incremental cost-effectiveness ratios more favorable (n = 15; 45%) or kept the intervention cost saving (n = 13; 39%) in most cases. In fewer cases, including spillover increased incremental costeffectiveness ratios (n = 2; 6%), kept the intervention dominated [more costs/less quality-adjusted life-years] (n = 2; 6%), or changed incremental cost-effectiveness ratio from dominated to less cost/less quality-adjusted life-years (n = 1; 3%). In 11 cases (33%), adding spillover effects into analyses resulted in a lower incremental cost-effectiveness ratio that crossed a common cost-effectiveness threshold, which could have downstream implications for programs or policies that are adopted based on cost-effectiveness analysis results. Discussion Most Alzheimer's disease/dementia cost-utility analyses incorporated spillover costs, often as caregiver time costs, but considered spillover health impacts less often. In about 85% of the analyses, including Alzheimer's disease/dementia spillover cost or health effects decreased incremental cost-effectiveness ratios or kept the intervention cost saving. The broader value of an Alzheimer's disease/dementia intervention to society may in some cases be underestimated without considering these spillover effects on family and informal caregivers.

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“…The memantine ER and ChEI combination compared with ChEI monotherapy alone in patients with moderate-to-severe AD was evaluated from a cost-effectiveness perspective. 54 A population was simulated based on the baseline characteristics from the MEM-MD-50 study. Disease progression was modeled for a period of 3 years based on predictive equations using changes in SIB, NPI, and ADCS-ADL-19 scores.…”

Section: Cost Analysismentioning

confidence: 99%

“…In the previous study, the difference in the mean amount of time spent in an institution over the 3-year period was more substantial, with an estimated 13.14 months for ChEI monotherapy and 9.15 months for memantine ER/ChEI combination. 54 …”

Section: Cost Analysismentioning

confidence: 99%

A fixed-dose combination of memantine extended-release and donepezil in the treatment of moderate-to-severe Alzheimer’s disease

Deardorff¹,

Grossberg²

2016

DDDT

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Currently available therapies for the treatment of Alzheimer’s disease (AD) consist of cholinesterase inhibitors (ChEIs), such as donepezil, and the N-methyl-D-aspartate receptor antagonist memantine. In December 2014, the US Food and Drug Administration approved Namzaric™, a once-daily, fixed-dose combination (FDC) of memantine extended-release (ER) and donepezil for patients with moderate-to-severe AD. The FDC capsule is bioequivalent to the coadministered individual drugs, and its bioavailability is similar when taken fasting, with food, or sprinkled onto applesauce. The combination of memantine and ChEIs in moderate-to-severe AD provides additional benefits to ChEI monotherapy across multiple domains and may delay the time to nursing home admission. A dedicated study of memantine ER compared to placebo in patients on a stable dose of a ChEI found statistically significant benefits on cognition and global status but not functioning. Treatment with memantine ER and donepezil is generally well tolerated, although higher doses of ChEIs are associated with more serious adverse events such as vomiting, syncope, and weight loss. Potential advantages of the FDC include a simpler treatment regimen, reduction in pill burden, and the ability to sprinkle the capsule onto soft foods. Patients who may benefit from the FDC include those with significant dysphagia, a history of poor compliance, or limited caregiver interaction. However, available evidence that these advantages would increase treatment adherence and persistence is conflicting, meaning that the added cost of switching patients from generic options to an FDC may not always be justified.

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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

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

Cited by 13 publications

References 27 publications

How relevant are social costs in economic evaluations? The case of Alzheimer’s disease

How relevant are social costs in economic evaluations? The case of Alzheimer’s disease

Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer’s Disease Interventions

A fixed-dose combination of memantine extended-release and donepezil in the treatment of moderate-to-severe Alzheimer’s disease

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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

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

Cited by 13 publications

References 27 publications

How relevant are social costs in economic evaluations? The case of Alzheimer’s disease

How relevant are social costs in economic evaluations? The case of Alzheimer’s disease

Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer’s Disease Interventions

A fixed-dose combination of memantine extended-release and donepezil in the treatment of moderate-to-severe Alzheimer&rsquo;s disease

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Product

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A fixed-dose combination of memantine extended-release and donepezil in the treatment of moderate-to-severe Alzheimer’s disease