Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil
Abstract
OBJECTIVE: The efficacy and safety of memantine in patients with moderate-to-severe Alzheimer's disease (AD) receiving stable doses of donepezil were recently demonstrated in a phase III trial. The cost-effectiveness of such therapy is unknown. RESEARCH DESIGN AND METHODS: A microsimulation model was developed to depict AD progression over time and associated clinical and economic outcomes. AD progression was measured in terms of decline in cognitive function, as assessed by the Severe Impairment Battery (SIB). At model entry, patients were assumed to have moderate-to-severe AD, to be on stable doses of donepezil, and to begin combination therapy with memantine, or continue to receive donepezil alone; duration of therapy was assumed to be 1 year. Drug efficacy was based on data from a phase III trial. Key assumptions of the model included: (1) efficacy of study drugs would extend to 1 year; (2) measures of cognitive function could be mapped to one another, as well as to global measures of disease severity; and (3) following therapy discontinuation, cognitive function would revert immediately to natural history levels. Cost-effectiveness was assessed in terms of cost (2005 US$) per quality-adjusted life-year (QALY) gained over a lifetime (3% discount rate). RESULTS: SIB scores were estimated to improve by 3.3 over 1 year from therapy with memantine plus donepezil (vs. donepezil alone). While pharmacotherapy costs were estimated to increase by $1250 during the year of memantine treatment, costs of formal and informal services were estimated to decrease by $1240 over this period and by $1493 (discounted present value) over a lifetime. Findings were sensitive to the assumed SIB score at therapy initiation; cost-effectiveness was better for patients with higher initial SIB scores (i.e., less severe disease). CONCLUSION: In patients with moderate-to-severe AD already receiving donepezil, treatment with memantine results in improved clinical outcomes and reduced total costs of care.
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Therapies that minimize caregiver burden and delay nursing home entry translate into significant benefits related to worker productivity and health care savings.
“From a public health and economics perspective, therapies that minimize caregiver burden and delay nursing home entry translate into significant benefits related to worker productivity and health care savings.66,[73][74][75]”
From The Alzheimer’s Disease Clinical Spectrum (2019) · cites this paper as [73]
In moderate and severe AD, short-term efficacy of memantine monotherapy compared with placebo is reported in several randomized controlled trials of 12 to 50 weeks duration and supported by meta-analyses.
“In moderate and severe AD, short-term efficacy of memantine monotherapy compared with placebo is reported in several RCTs of 12 to 50 weeks duration and supported by meta-analyses.”
From The Alzheimer’s Disease Clinical Spectrum (2019) · cites this paper as [73]
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- Authors
- Weycker, D., Taneja, C., Edelsberg, J., Haim Erder, M., Schmitt, F. A., Setyawan, J., & Oster, G.
- Affiliations
- Policy Analysis (United States) (US)
- Forest Laboratories, Inc., New York, New York, USA
- University of Kentucky (US)
- Forest Laboratories (United States) (US)
- Corresponding author
- Weycker, Derek
- Venue
- Current Medical Research and Opinion
- Publisher
- Informa Healthcare
- Published
- 2007-04-20
- Volume
- 23
- Issue
- 5
- Pages
- 1187-1197
- ISSN
- 0300-7995 (ISSN-L)
- 1473-4877
- OpenAlex
- W2110353868
- Cited by
- 52
- References
- 28
- Citations by year
- 2025: 1 · 2024: 2 · 2022: 1 · 2021: 1 · 2019: 7 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 4 · 2014: 3 · 2013: 3 · 2012: 4
- FWCI
- 10.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Medical Research and Opinion (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Myriad Genetics
- Forest Laboratories
- National Institute on Aging (R01AG019241, P50AG005144, P50AG-05144, R01 AG19241)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Keywords
- memantine, donepezil, Alzheimer's disease, cost-effectiveness, combination therapy, microsimulation model, Severe Impairment Battery, cognitive decline, quality-adjusted life years, care costs, disease progression
- MeSH terms
- Donepezil, Aged, Aged, 80 and over, Alzheimer Disease, Cost-Benefit Analysis, Drug Therapy, Combination, Female, Humans, Indans, Male, Memantine, Piperidines, Models, Econometric, Clinical Trials, Phase III as Topic, Nootropic Agents
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