Donepezil for the Treatment of Mild to Moderate Alzheimer’s Disease in France: The Economic Implications

Abstract

In the present study, the socioeconomic impact of the use of the acetylcholinesterase inhibitor donepezil in patients with mild to moderate Alzheimer’s disease (AD) living in France was examined. A model was created to extrapolate over a 3-year period the results from placebo-controlled trials together with epidemiological and prevalence data. Costs considered in the model were net societal costs associated with paid and unpaid assistance, general medical consumption and institutional care. The model suggested that delays in cognitive decline and functional dependence due to treatment reduced the time spent in institutional care and the burden on caregivers. Over a 3-year period, total net costs of caring for untreated patients with an initial Mini-Mental State Examination score ranging from 10 to 26 were EUR 53,206 compared with EUR 42,720 for a patient treated with donepezil – an annual cost saving of approximately EUR 3,500 per patient. Cost savings were mainly due to savings in unpaid caregiver time, which, apart from patient institutionalization, represented the most costly component of total care in this study but had no direct budgetary impact. Overall, these data suggest that donepezil is a cost-effective treatment for mild to moderately impaired AD patients living in France.

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.…”

“…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. with savings for patients and caregivers, but not for the healthcare system or social services).…”

“…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.…”

“…Three studies obtained transition probabilities for donepezil-treated and untreated groups from clinical trial data, 84,85,89 one study 82 used epidemiological data for the untreated group and trial data for the donepezil treated group and the others used epidemiological data to calculate transition probabilities for the untreated group and then applied a risk reduction factor derived from clinical trial data to generate transition probabilities for the treatment group. 84,86,87 In some studies the effect of donepezil on disease progression was assumed to last for only part of the overall time horizon, 82,85,89 but other studies assumed that the treatment effect persisted for the entire time horizon. 84,86,87 Generally models incorporated an on-going mortality risk that was the same for both treated and untreated patients; this mortality risk was dependent on disease severity in three studies.…”