The Pharmacoeconomics of Cognitive Enhancers in Moderate to Severe Alzheimerʼs Disease
Abstract
Alzheimer's disease is associated with a substantial economic impact on patients, their caregivers and society. Due to the current rise in the aging population, the prevalence and impact of Alzheimer's disease are expected to increase greatly. The cost of caring for someone with Alzheimer's disease is magnified in the more severe stages of the disease. There are four cognitive enhancers commonly used for the treatment of Alzheimer's disease: three cholinesterase inhibitors (donepezil, rivastigmine and galantamine) and one NMDA receptor antagonist (memantine). Of these, donepezil and memantine have been approved in many countries as pharmacological treatments for moderate to severe Alzheimer's disease, while donepezil, rivastigmine and galantamine are approved treatments for mild to moderate Alzheimer's disease. While cost effectiveness has been well studied in mild to moderate Alzheimer's disease, the cost-benefit information for drug therapy in moderate to severe Alzheimer's disease is less clear. This article reviews the pharmacoeconomic data available on these four drugs, with a specific focus on moderate to severe Alzheimer's disease, including economic burden, cost drivers, clinical outcomes and pharmacoeconomic studies. A key driver of the cost of Alzheimer's disease is the severity of the disease, indicating that the ability to stabilize the disease state is a potential source of cost savings. Drug therapies that can limit increases in behavioural problems and cognitive and functional impairment, and postpone institutionalization without an increase in longevity may serve to reduce the economic burden on Alzheimer's disease patients. The data suggest that, while the available, approved agents offer only modest improvements in clinical outcomes, they could be cost-effective treatments for moderate to severe Alzheimer's disease when viewed from the societal perspective. For memantine and donepezil, data are available that suggest that the cost of these drugs is offset by the clinical and societal benefits provided by slowing the progression of Alzheimer's disease. While there are few head-to-head comparison trials, the similarity in costs of the treatments and efficacy against placebo suggest that cost effectiveness will not be substantially different among treatments. More studies that examine longitudinal resource utilization and its relationship to drug treatment in the moderate to severe stages are needed to clarify cost benefit in this population and possibly differentiate between individual medications.
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Anti-AD pharmacotherapy (donepezil, memantine, galantamine, rivastigmine) can reduce the economic burden of the illness, even in later stages of illness.
“Viewed from the social perspective, anti-AD pharmacotherapy (donepezil, memantine, galantamine, rivastigmine) can reduce the economic burden of the illness, even in later stages of illness.66”
From The Alzheimer’s Disease Clinical Spectrum (2019) · cites this paper as [66]
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 [66]
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
Functional evaluation : Barthel index
Mahonery, F. I. (1965) · Medical Entomology and Zoology · Cited by 12,762 · see citing works
The Clinical Dementia Rating (CDR): Current version and scoring rules
Morris, J. C. (1993) · Neurology · doi:10.1212/wnl.43.11.2412-a · Cited by 9,882 · see citing works
The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994) · Neurology · doi:10.1212/wnl.44.12.2308 · Cited by 7,568 · see citing works
Global prevalence of dementia: a Delphi consensus study
Ferri, C. P., Prince, M. J., Brayne, C., Brodaty, H., Fratiglioni, L., Ganguli, M., Hall, K. S., Hasegawa, K., Hendrie, H. C., Huang, Y., et al. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67889-0 · Cited by 5,336 · see citing works
Pfeiffer, E. A. (1975) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1975.tb00927.x · Cited by 5,320 · see citing works
The Global Deterioration Scale for assessment of primary degenerative dementia
Reisberg, ., Ferris, S. H., de Leon, M. J., & Crook, T. H. (1982) · American Journal of Psychiatry · doi:10.1176/ajp.139.9.1136 · Cited by 4,982 · see citing works
Blessed, G., Tomlinson, B. E., & Roth, M. (1968) · British Journal of Psychiatry · doi:10.1192/bjp.114.512.797 · Cited by 4,117 · see citing works
Forecasting the global burden of Alzheimer's disease
Brookmeyer, R., Johnson, E., Ziegler‐Graham, K., & Arrighi, H. M. (2007) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2007.04.381 · Cited by 3,370 · see citing works
Memantine in Moderate-to-Severe Alzheimer's Disease
Reisberg, B., Doody, R., Stöffler, A., Schmitt, F., Ferris, S., & Möbius, H. J. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa013128 · Cited by 2,043 · see citing works
Cholinesterase inhibitors for Alzheimer's disease
Birks, J. S. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005593 · Cited by 1,906 · see citing works
Shunk, A. W., Davis, A. S., & Dean, R. S. (2006) · Applied Neuropsychology · doi:10.1207/s15324826an1304_9 · Cited by 1,528 · see citing works
Tariot, P. N., Farlow, M. R., Grossberg, G. T., Graham, S. M., McDonald, S., Gergel, I., & for the Memantine Study Group (2004) · JAMA · doi:10.1001/jama.291.3.317 · Cited by 1,403 · see citing works
Donepezil for dementia due to Alzheimer’s disease.
Birks, J. S., & Harvey, R. J. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001190.pub3 · Cited by 1,200 · see citing works
An Inventory to Assess Activities of Daily Living for Clinical Trials in Alzheimerʼs Disease
Galasko, D., Bennett, D. A., Sano, M., Ernesto, C., Thomas, R., Grundman, M., & Ferris, S. H. (1997) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-199700112-00005 · Cited by 1,198 · see citing works
McShane, R., Areosa Sastre, A., & Minakaran, N. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003154.pub5 · Cited by 1,155 · see citing works
A 30-Week Randomized Controlled Trial of High-Dose Tacrine in Patients With Alzheimer's Disease
Knapp, M. J. (1994) · JAMA · doi:10.1001/jama.271.13.985 · Cited by 997 · see citing works
Hepatotoxic Effects of Tacrine Administration in Patients With Alzheimer's Disease
Watkins, P. B. (1994) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1994.03510370044030 · Cited by 829 · see citing works
Raina, P., Santaguida, P., Ismaila, A., Patterson, C., Cowan, D., Levine, M., Booker, L., & Oremus, M. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-148-5-200803040-00009 · Cited by 771 · see citing works
Galasko, D. R., Bennett, D., Sano, M., Ernesto, C., Thomas, R., Grundman, M., & Ferris, S. H. (1997) · PubMed · Cited by 767 · see citing works
The worldwide societal costs of dementia: Estimates for 2009
Wimo, A., Winblad, B. G., & Jönsson, L. (2010) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2010.01.010 · Cited by 628 · see citing works
A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease
Feldman, H., Gauthier, S. G., Hecker, J., Vellas, B. J., Subbiah, P., Whalen, E., & the Donepezil MSAD Study Investigators Group* (2001) · Neurology · doi:10.1212/wnl.57.4.613 · Cited by 600 · see citing works
Michaelis, E. K. (1998) · Progress in Neurobiology · doi:10.1016/s0301-0082(97)00055-5 · Cited by 576 · see citing works
Rivastigmine for Alzheimer’s disease.
Birks, J. S., Chong, L.-Y., & Grimley Evans, J. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001191.pub4 · Cited by 534 · see citing works
Hansen, R. A., Webb, A. P., Moore, C. G., Gartlehner, G., Jonas, D. E., & Morgan, L. C. (2020) · PubMed Central · doi:10.17615/ae8c-2p76 · Cited by 523 · see citing works
To: A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease
(2001) · Neurology · doi:10.1212/wnl.57.11.2153-a · Cited by 490 · see citing works
National Estimates of the Quantity and Cost of Informal Caregiving for the Elderly with Dementia*
Langa, K. M., Chernew, M. E., Kabeto, M. U., Herzog, A. R., Ofstedal, M. B., Willis, R. J., Wallace, R. B., Mucha, L., Straus, W. L., & Fendrick, A. M. (2001) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2001.10123.x · Cited by 456 · see citing works
Winblad, B. G., Kilander, L., Eriksson, S., Minthon, L., Båtsman, S., Wetterholm, A.-L., Jansson-Blixt, C., & Haglund, A. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68350-5 · Cited by 388 · see citing works
Diagnosis and treatment of dementia: 2. Diagnosis
Feldman, H., Jacova, C., Robillard, A., Garcia, A. A., Chow, T. W., BORRIE, M. J., Schipper, H. M., Blair, M., Kertesz, A., & Chertkow, H. M. (2008) · Canadian Medical Association Journal · doi:10.1503/cmaj.070798 · Cited by 350 · see citing works
Qaseem, A., Snow, V. T., Cross, J. T., Forciea, M. A., HOPKINS, R. H., Shekelle, P., Adelman, A., Mehr, D. R., Schellhase, K. G., Campos-Outcalt, D. E., et al. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-148-5-200803040-00008 · Cited by 350 · see citing works
Galantamine for Alzheimer's disease and mild cognitive impairment
Loy, C. T., & Schneider, L. S. S. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001747.pub3 · Cited by 335 · see citing works
Farlow, M., Anand, R., Messina Jr, J., Hartman, R., & Veach, J. (2000) · European Neurology · doi:10.1159/000008243 · Cited by 332 · see citing works
Panisset, M. (1994) · Archives of Neurology · doi:10.1001/archneur.1994.00540130067012 · Cited by 321 · see citing works
An estimate of the total worldwide societal costs of dementia in 2005
Wimo, A., Winblad, B., & Jönsson, L. (2007) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2007.02.001 · Cited by 300 · see citing works
Psychiatric Symptoms Vary With the Severity of Dementia in Probable Alzheimer's Disease
Lopez, O. L., Becker, J. T., Sweet, R. A., Klunk, W., Kaufer, D. I., Saxton, J., Habeych, M., & DeKosky, S. T. (2003) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.15.3.346 · Cited by 286 · see citing works
Schnaider Beeri, M., Werner, P., Davidson, M., & Noy, S. (2002) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.490 · Cited by 284 · see citing works
Lopez, O. L., Becker, J. T., Wahed, A. S., Saxton, J., Sweet, R. A., Wolk, D. A., Klunk, W., & DeKosky, S. T. (2009) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.2008.158964 · Cited by 266 · see citing works
Hébert, R., Dubois, M., Wolfson, C. M., Chambers, L. W., & Cohen, C. A. (2001) · The Journals of Gerontology Series A · doi:10.1093/gerona/56.11.m693 · Cited by 263 · see citing works
Donepezil preserves cognition and global function in patients with severe Alzheimer disease
Black, S. E., Doody, R., Li, H., McRae, T. D., Jambor, K. M., Xu, Y., Sun, Y., Perdomo, C. A., & Richardson, S. (2007) · Neurology · doi:10.1212/01.wnl.0000266627.96040.5a · Cited by 255 · see citing works
Memantine in Moderate to Severe Alzheimer’s Disease: a Meta-Analysis of Randomised Clinical Trials
Winblad, B. G., Jones, R. W., Wirth, Y., Stöffler, A., & Möbius, H. J. (2007) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000102568 · Cited by 253 · see citing works
Wilcock, G. K., Ballard, C. G., Cooper, J. A., & Loft, H. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0302 · Cited by 253 · see citing works
Alzheimer's Disease Care: Costs And Potential Savings
Leon, J., Cheng, C.-K., & Neumann, P. J. (1998) · Health Affairs · doi:10.1377/hlthaff.17.6.206 · Cited by 250 · see citing works
Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease
Neumann, P. J., Hermann, R. C., Kuntz, K. M., Araki, S. S., Duff, S. B., Leon, J., Berenbaum, P. A., Goldman, P. A., Williams, L. W., & Weinstein, M. C. (1999) · Neurology · doi:10.1212/wnl.52.6.1138 · Cited by 245 · see citing works
The contribution of neuropsychiatric symptoms to the cost of dementia care
Herrmann, N., Lanctôt, K. L., Sambrook, R., Lesnikova, N., Hébert, R., McCracken, P., Robillard, A., & Nguyen, E. H. L. (2006) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1594 · Cited by 232 · see citing works
Self-citationBullock, R. A., Touchon, J., Bergman, H., Gambina, G., He, Y., Rapatz, G., Nagel, J., & Lane, R. M. (2005) · Current Medical Research and Opinion · doi:10.1185/030079905x56565 · Cited by 228 · see citing works
Relation between severity of Alzheimer's disease and costs of caring.
Hux, M., O’Brien, B. J., Iskedjian, M., Goeree, R. A., Gagnon, M., & Gauthier, S. G. (1998) · Europe PMC (PubMed Central) · Cited by 227 · see citing works
Determinants of costs of care for patients with Alzheimer's disease
Jönsson, L., Eriksdotter, M., Kilander, L., Soininen, H. S., Hallikainen, M., Waldemar, G., Nygaard, H. A., Andreasen, N., Winblad, B. G., & Wimo, A. B. (2006) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1489 · Cited by 220 · see citing works
Gauthier, S., Loft, H., & Cummings, J. (2008) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1949 · Cited by 220 · see citing works
Carpenter, G., Hastie, C. L., Morris, J. N., Fries, B. E., & Ankri, J. (2006) · BMC Geriatrics · doi:10.1186/1471-2318-6-7 · Cited by 212 · see citing works
van Dyck, C. H., Tariot, P. N., Meyers, B. S., & Resnick, E. M. (2007) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e318065c495 · Cited by 181 · see citing works
A 24-Week Open-Label Extension Study of Memantine in Moderate to Severe Alzheimer Disease
Reisberg, ., Doody, R. S., Stöffler, A., Schmitt, F. A., Ferris, S. H., & Möbius, H. J. (2006) · Archives of Neurology · doi:10.1001/archneur.63.1.49 · Cited by 181 · see citing works
Homma, A., Takeda, M., Imai, Y., Udaka, F., Hasegawa, K., Kameyama, M., & Nishimura, T. (2000) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000017259 · Cited by 177 · see citing works
Cognitive Function and the Costs of Alzheimer Disease
Ernst, R. L. (1997) · Archives of Neurology · doi:10.1001/archneur.1997.00550180013006 · Cited by 172 · see citing works
Caregiver Characteristics Are Associated with Neuropsychiatric Symptoms of Dementia
Sink, K. M., Covinsky, K. E., Barnes, D. E., Newcomer, R. J., & Yaffe, K. S. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00697.x · Cited by 167 · see citing works
Wimo, A. B., Winblad, B. G., Stöffler, A., Wirth, Y., & Moebius, H. J. (2003) · PharmacoEconomics · doi:10.2165/00019053-200321050-00004 · Cited by 165 · see citing works
Burns, A. S., Bernabei, R., Bullock, R. A., Cruz-Jentoft, A. J., Frölich, L., Höck, C., Raivio, M., Triau, E., Vandewoude, M. F. J., Wimo, A. B., et al. (2008) · The Lancet Neurology · doi:10.1016/s1474-4422(08)70261-8 · Cited by 154 · see citing works
Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease
Herrmann, N., & Gauthier, S. (2008) · Canadian Medical Association Journal · doi:10.1503/cmaj.070804 · Cited by 140 · see citing works
Self-citationGalantamine for vascular cognitive impairment
Birks, J., & Craig, D. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004746.pub2 · Cited by 135 · see citing works
Measuring Alzheimer’s disease progression with transition probabilities
Neumann, P. J., Araki, S. S., Arcelus, A., Longo, A., Papadopoulos, G., Kosik, K. S., Kuntz, K. M., & Bhattacharjya, A. S. (2001) · Neurology · doi:10.1212/wnl.57.6.957 · Cited by 114 · see citing works
Clinical Global Impression of Change Clinical Global Impressions in Alzheimer’s Clinical Trials
Schneider, L. S. S., & Olin, J. T. (1996) · International Psychogeriatrics · doi:10.1017/s1041610296002645 · Cited by 113 · see citing works
Cross Sectional Observational Study on the Societal Costs of Alzheimers Disease
Mesterton, J., Wimo, A. B., By, A., Langworth, S., Winblad, B. G., & Jönsson, L. (2010) · Current Alzheimer Research · doi:10.2174/156720510791162430 · Cited by 111 · see citing works
Allegri, R., Butman, J., Arizaga, R. L., Machnicki, G., Serrano, C. M., Taragano, F. E., Sarasola, D., & Loñ, L. (2006) · International Psychogeriatrics · doi:10.1017/s1041610206003784 · Cited by 111 · see citing works
Feldman, H., Gauthier, S. G., Hecker, J. R., Vellas, B. J., Xu, Y., Ieni, J. R., & Schwam, E. M. (2005) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1325 · Cited by 110 · see citing works
The Impact of Symptom Severity on the Cost of Alzheimer's Disease
Small, G. W., McDonnell, D. D., Brooks, R. L., & Papadopoulos, G. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50065.x · Cited by 108 · see citing works
DANTOINE, T. F., Auriacombe, S., Sarazin, M., Becker, H., Pere, J.-J., & Bourdeix, I. (2005) · International Journal of Clinical Practice · doi:10.1111/j.1368-5031.2005.00769.x · Cited by 106 · see citing works
Taylor, D. H., Schenkman, M. L., Zhou, J., & Sloan, F. A. (2001) · The Journals of Gerontology Series B · doi:10.1093/geronb/56.5.s285 · Cited by 104 · see citing works
Estimating the relationship between disease progression and cost of care in dementia
Wolstenholme, J. L., Fenn, P., Gray, A. M., Keene, J., Jacoby, R. J., & Hope, T. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.181.1.36 · Cited by 101 · see citing works
Social-economic costs and quality of life of Alzheimer disease in the Canary Islands, Spain
López‐Bastida, J., Serrano‐Aguilar, P., Perestelo‐Pérez, L., & Oliva, J. (2006) · Neurology · doi:10.1212/01.wnl.0000249311.80411.93 · Cited by 100 · see citing works
Economic impact of Alzheimer's disease in the United Kingdom
Souêtre, E., Thwaites, R., & Yeardley, H. L. (1999) · The British Journal of Psychiatry · doi:10.1192/bjp.174.1.51 · Cited by 98 · see citing works
Homma, A., Imai, Y., Tago, H., Asada, T., Shigeta, M., Iwamoto, T., Takita, M., Arimoto, I., Koma, H., & Ohbayashi, T. (2008) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000122961 · Cited by 92 · see citing works
Diagnosis and Treatment of Patients with Severe Alzheimer’s Disease
Voisin, T., & Vellas, B. (2009) · Drugs & Aging · doi:10.2165/0002512-200926020-00005 · Cited by 89 · see citing works
Wilkinson, D. G., & Andersen, H. F. (2007) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000105162 · Cited by 84 · see citing works
Economic evaluation of donepezil in moderate to severe Alzheimer disease
Feldman, H., Gauthier, S. G., Hecker, J. R., Vellas, B. J., Hux, M., Xu, Y., Schwam, E. M., Shah, S., & Mastey, V. (2004) · Neurology · doi:10.1212/01.wnl.0000134663.79663.6e · Cited by 84 · see citing works
Hill, J. W., Fillit, H. M., Thomas, S. K., & Chang, S. (2006) · PharmacoEconomics · doi:10.2165/00019053-200624030-00006 · Cited by 81 · see citing works
Coduras, A., Rabasa, I., Frank, A., Bermejo‐Pareja, F., Pousa, S. L., López-Arrieta, J.-M., del Llano, J., León, T., & Rejas, J. (2010) · Journal of Alzheimer s Disease · doi:10.3233/jad-2010-1258 · Cited by 80 · see citing works
Clinical features associated with costs in early AD
Zhu, C. W., Scarmeas, N., Torgan, R., Albert, M., Brandt, J., Blacker, D., Sano, M. E. B., & Stern, Y. (2006) · Neurology · doi:10.1212/01.wnl.0000204189.18698.c7 · Cited by 73 · see citing works
Feldman, H., Schmitt, F. A., & Olin, J. T. (2006) · Alzheimer Disease & Associated Disorders · doi:10.1097/01.wad.0000213859.35355.59 · Cited by 71 · see citing works
Feldman, H., Pirttilä, T., Dartigues, J., Everitt, B. J., van Baelen, B., Schwalen, S., & Kavanagh, S. (2008) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2141 · Cited by 67 · see citing works
Livingston, G., Katona, C., Roch, B., Guilhaume, C., & Rive, B. (2004) · Current Medical Research and Opinion · doi:10.1185/030079904125003980 · Cited by 64 · see citing works
Cost Effectiveness of Memantine in Alzheimer???s Disease
Jones, R. W., McCrone, P., & Guilhaume, C. (2004) · Drugs & Aging · doi:10.2165/00002512-200421090-00005 · Cited by 63 · see citing works
Emre, M., Mecocci, P., & Stender, K. (2008) · Journal of Alzheimer s Disease · doi:10.3233/jad-2008-14207 · Cited by 60 · see citing works
Donepezil treatment in severe Alzheimer's disease: a pooled analysis of three clinical trials
Winblad, B. G., Black, S. E., Homma, A., Schwam, E. M., Moline, M. L., Xu, Y., Perdomo, C. A., Swartz, J., & Albert, K. S. (2009) · Current Medical Research and Opinion · doi:10.1185/03007990903236731 · Cited by 60 · see citing works
Economics of dementia and pharmacoeconomics of dementia therapy
Fillit, H. M., & Hill, J. W. (2005) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2005.03.005 · Cited by 58 · see citing works
Memantine: efficacy and safety in mild-to-severe Alzheimer's disease
Tampi, R. R., & van Dyck, C. H. (2007) · Neuropsychiatric Disease and Treatment · doi:10.2147/nedt.2007.3.2.245 · Cited by 57 · see citing works
Patients with Alzheimer's Disease Living at Home in France: Costs and Consequences of the Disease
Rigaud, A., Bayle, C., Fagnani, F., Latour, F., Traykov, L. D., & Forette, F. (2003) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988703252558 · Cited by 57 · see citing works
Medical Management of Advanced Dementia
Tariot, P. N. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.5156.x · Cited by 54 · see citing works
Weycker, D., Taneja, C., Edelsberg, J., Haim Erder, M., Schmitt, F. A., Setyawan, J., & Oster, G. (2007) · Current Medical Research and Opinion · doi:10.1185/030079907x188071 · Cited by 52 · see citing works
Is donepezil therapy associated with reduced mortality in nursing home residents with dementia?
Gasper, M. C., Ott, B. R., & Lapane, K. L. (2005) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2005.02.001 · Cited by 51 · see citing works
Treatment effects of Memantine on language in moderate to severe Alzheimer's disease patients
Ferris, S. H., Ihl, R., Robert, P. H., Winblad, B. G., Gatz, G., Tennigkeit, F., & Gauthier, S. G. (2009) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2009.05.604 · Cited by 50 · see citing works
Cost Effectiveness of Memantine in???Moderately Severe to Severe Alzheimer???s Disease
Fran??ois, C., Sintonen, H., Sulkava, R. O., & Rive, B. (2004) · Clinical Drug Investigation · doi:10.2165/00044011-200424070-00001 · Cited by 49 · see citing works
Marin, D. B., Amaya, K., Casciano, R., Puder, K. L., Casciano, J., Cuccia, A. J., Chang, S., Snyder, E. H., & Cheng, I. (2003) · International Psychogeriatrics · doi:10.1017/s1041610203009633 · Cited by 43 · see citing works
Cost-effectiveness of memantine for moderate to severe Alzheimer's disease in Sweden
Jönsson, L. (2005) · The American journal of geriatric pharmacotherapy · doi:10.1016/j.amjopharm.2005.05.002 · Cited by 42 · see citing works
Clinical Use of Cholinomimetic Agents
Blount, P. J., Nguyen, C. D., & McDeavitt, J. T. (2002) · Journal of Head Trauma Rehabilitation · doi:10.1097/00001199-200208000-00005 · Cited by 39 · see citing works
Plosker, G. L., & Lyseng-Williamson, K. A. (2005) · PharmacoEconomics · doi:10.2165/00019053-200523020-00010 · Cited by 38 · see citing works
Gagnon, M., Rive, B., Hux, M., & Guilhaume, C. (2007) · The Canadian Journal of Psychiatry · doi:10.1177/070674370705200810 · Cited by 37 · see citing works
The Economics of Alzheimer Disease
Leung, G. M., Yeung, R., Chi, I., & Chu, L. (2002) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000066675 · Cited by 37 · see citing works
Donepezil use in managed medicare: Effect on health care costs and utilization
Fillit, H. M., Gutterman, E. M., & Lewis, B. (1999) · Clinical Therapeutics · doi:10.1016/s0149-2918(00)87246-x · Cited by 33 · see citing works
Galantamine-ER for the treatment of mild-to-moderate Alzheimer’s disease
Seltzer, B. (2009) · Clinical Interventions in Aging · doi:10.2147/cia.s4819 · Cited by 32 · see citing works
Fagnani, F., Lafuma, A. J., Péchevis, M., Rigaud, A., Traykov, L., Seux, M., & Forette, F. (2003) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000074079 · Cited by 32 · see citing works
Antoñanzas, F., Rive, B., Badenas, J. M., Gómez-Lus, S., & Guilhaume, C. (2006) · The European Journal of Health Economics · doi:10.1007/s10198-006-0355-0 · Cited by 31 · see citing works
Can we do better in developing new drugs for Alzheimer's disease?
Gauthier, S. G., & Scheltens, P. (2009) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2009.09.002 · Cited by 30 · see citing works
Pousa, S. L., Garre‐Olmo, J., Franch, J. V., Estrada, A. T., Cors, O. S., Nierga, I. P., & Gelada-Batlle, E. (2006) · Age and Ageing · doi:10.1093/ageing/afj083 · Cited by 29 · see citing works
Cost effectiveness of memantine in Alzheimer's disease in the UK
Rive, B., Grishchenko, M., Guilhaume, C., Katona, C., Livingston, G., Lamure, M. P., Toumi, M., & François, C. (2010) · Journal of Medical Economics · doi:10.3111/13696998.2010.491347 · Cited by 28 · see citing works
Lyseng-Williamson, K. A., & Plosker, G. L. (2002) · PharmacoEconomics · doi:10.2165/00019053-200220130-00005 · Cited by 25 · see citing works
Analyses of mortality risk in patients with dementia treated with galantamine
Feldman, H., Pirttilä, T., Dartigues, J., Everitt, B. J., van Baelen, B., Brashear, H. R., Berlin, J. A., Battisti, W. P., & Kavanagh, S. (2008) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.2008.01047.x · Cited by 22 · see citing works
Economic Aspects on Drug Therapy of Dementia
Wimo, A., & Winblad, B. G. (2004) · Current Pharmaceutical Design · doi:10.2174/1381612043386400 · Cited by 15 · see citing works
The Costs of Caring: Medical Costs of Alzheimer's Disease and The Managed Care Environment
Murman, D. L. (2001) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/089198870101400402 · Cited by 11 · see citing works
FDA approves memantine drug for treating AD.
(2003) · PubMed · Cited by 11 · see citing works
Bianchetti, A., Castelletti, F., & Trabucchi, M. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.181.6.533 · Cited by 4 · see citing works
(1965) · PubMed
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1 of the 112 references couldn’t be matched to a known paper.
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The Alzheimer’s Disease Clinical Spectrum
Atri, A. (2019) · Medical Clinics of North America · doi:10.1016/j.mcna.2018.10.009 · Cited by 623 · see citing works
“Viewed from the social perspective, anti-AD pharmacotherapy (donepezil, memantine, galantamine, rivastigmine) can reduce the economic burden of the illness, even in later stages of illness.(66)”
Current and future treatments in Alzheimer’s disease
Atri, A. (2019) · Seminars in Neurology · doi:10.1055/s-0039-1678581 · Cited by 309 · see citing works
Therapeutic Approach to Alzheimer’s Disease: Current Treatments and New Perspectives
Pardo-Moreno, T., González-Acedo, A., Rivas-Domínguez, A., García-Morales, V., García-Cozar, F. J., Ramos-Rodríguez, J. J., & Melguizo-Rodríguez, L. (2022) · Pharmaceutics · doi:10.3390/pharmaceutics14061117 · Cited by 239 · see citing works
Current and Emerging Drug Treatment Options for Alzheimerʼs Disease
Herrmann, N., Chau, S. A., Kircanski, I., & Lanctôt, K. L. (2011) · Drugs · doi:10.2165/11595870-000000000-00000 · Cited by 238 · see citing works
Self-citationDou, K.-X., Tan, M.-S., Tan, C.-C., Cao, X.-P., Hou, X.-H., Guo, Q.-H., Tan, L., Mok, V., & Yu, J.-T. (2018) · Alzheimer's Research & Therapy · doi:10.1186/s13195-018-0457-9 · Cited by 171 · see citing works
Guo, J., Wang, Z., Liu, R., Huang, Y., Zhang, N., & Zhang, R. (2020) · Brain and Behavior · doi:10.1002/brb3.1831 · Cited by 165 · see citing works
Dementia care costs and outcomes: a systematic review
Knapp, M., Iemmi, V., & Romeo, R. (2013) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3864 · Cited by 126 · see citing works
Saoji, S. D., Raut, N. A., Dhore, P. W., Borkar, C. D., Popielarczyk, M., & Dave, V. S. (2015) · The AAPS Journal · doi:10.1208/s12248-015-9837-2 · Cited by 110 · see citing works
Quintana-Hernández, D. J., Miró-Barrachina, M. T., Ibáñez-Fernández, I. J., Pino, A. S.-D., Quintana-Montesdeoca, M. P., Rodríguez-de Vera, B., Morales-Casanova, D., Pérez-Vieitez, M. D. C., Rodríguez-García, J., & Bravo-Caraduje, N. (2016) · Journal of Alzheimer's Disease · doi:10.3233/jad-143009 · Cited by 107 · see citing works
Babiloni, C., Percio, C. D., Bordet, R., Bourriez, J., Bentivoglio, M., Payoux, P., Derambure, P., Dix, S. L., Infarinato, F., Lizio, R., et al. (2012) · Clinical Neurophysiology · doi:10.1016/j.clinph.2012.09.017 · Cited by 97 · see citing works
Cognitive Enhancers (Nootropics). Part 1: Drugs Interacting with Receptors
Froestl, W., Muhs, A., & Pfeifer, A. (2012) · Journal of Alzheimer s Disease · doi:10.3233/jad-2012-121186 · Cited by 91 · see citing works
CSF biomarkers in neurodegenerative diseases
Mattsson, N. (2011) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.2011.082 · Cited by 74 · see citing works
Memantine in dementia: a review of the current evidence
Herrmann, N., Li, A., & Lanctôt, K. L. (2011) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2011.558006 · Cited by 69 · see citing works
Self-citationSrivastava, S., & Haigis, M. C. (2011) · Current Pharmaceutical Design · doi:10.2174/138161211798072526 · Cited by 69 · see citing works
Cummings, J. L., Geldmacher, D., Farlow, M. R., Sabbagh, M. N., Christensen, D. D., & Betz, P. (2013) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.12076 · Cited by 64 · see citing works
Maxwell, C. J., Stock, K. J., Seitz, D. P., & Herrmann, N. (2014) · The Canadian Journal of Psychiatry · doi:10.1177/070674371405901203 · Cited by 64 · see citing works
Self-citationZhang, W., Zhang, W., Li, Z., Hao, J., Zhang, Z., Liu, L., Mao, N., Miao, J., & Zhang, L. (2011) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2011.09.012 · Cited by 60 · see citing works
Pharmacological Treatment of Dementia: A Scoping Review of Systematic Reviews
van de Glind, E. M. M., van Enst, W. A., Munster, B. C. V., Rikkert, M. G. M. O., Scheltens, P., Scholten, R. J. P. M., & Hooft, L. (2013) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000353892 · Cited by 55 · see citing works
Assessing Dementia in Resource-Poor Regions
Maestre, G. E. (2012) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-012-0300-9 · Cited by 52 · see citing works
Alzheimer's Therapeutics: Translation of Preclinical Science to Clinical Drug Development
Savonenko, A. V., Melnikova, T., Hiatt, A., Li, T., Worley, P. F., Troncoso, J. C., Wong, P. C., & Price, D. L. (2011) · Neuropsychopharmacology · doi:10.1038/npp.2011.211 · Cited by 52 · see citing works
How relevant are social costs in economic evaluations? The case of Alzheimer’s disease
Peña-Longobardo, L. M., Rodríguez-Sánchez, B., Oliva-Moreno, J., Aranda-Reneo, I., & López‐Bastida, J. (2019) · The European Journal of Health Economics · doi:10.1007/s10198-019-01087-6 · Cited by 33 · see citing works
Fukunaga, K., Sakai, D., Watanabe, K., Nakayama, K., Kohara, T., Tanaka, H., Sunada, S., Nabeno, M., Okamoto, M., Saito, K.-I., et al. (2015) · Bioorganic & Medicinal Chemistry Letters · doi:10.1016/j.bmcl.2015.01.005 · Cited by 32 · see citing works
Cognitive Enhancers (Nootropics). Part 2: Drugs Interacting with Enzymes
Froestl, W., Muhs, A., & Pfeifer, A. (2013) · Journal of Alzheimer s Disease · doi:10.3233/jad-2012-121537 · Cited by 31 · see citing works
Yu, Q., Reale, M., Kamal, M. A., Holloway, H. W., Luo, W., Sambamurti, K., Ray, B., Lahiri, D. K., Rogers, J. T., & Greig, N. H. (2013) · Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry · doi:10.2174/1871523011312020003 · Cited by 28 · see citing works
Visualization of cysteine in AD mouse with a high-quantum yield NIR fluorescent probe
Zhou, Z., Fang, C., Yu, F., Shen, Y., Xu, H., Li, H., & Zhang, Y. (2024) · Talanta · doi:10.1016/j.talanta.2024.126482 · Cited by 22 · see citing works
Wang, X., Zhang, Y., Niu, H., Geng, Y., Wang, B., Yang, X., Yan, P., Li, Q., & Kai-shun, B. (2017) · Journal of Separation Science · doi:10.1002/jssc.201601343 · Cited by 19 · see citing works
Yunusa, I. U., Alsahali, S. M., Rane, A., & Eguale, T. (2021) · Journal of Alzheimer s Disease Reports · doi:10.3233/adr-210307 · Cited by 19 · see citing works
Mai, Y., Yu, Q., Zhu, F., Luo, Y., Liao, W., Zhao, L., Xu, C., Fang, W., Ruan, Y., Cao, Z., et al. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-201033 · Cited by 18 · see citing works
Sawant‐Basak, A., Coffman, K. J., Walker, G. S., Ryder, T. F., Tseng, E., Miller, E. L., Lee, C., Vanase-Frawley, M. A., Wong, J. W., Brodney, M. A., et al. (2013) · Journal of Pharmaceutical Sciences · doi:10.1002/jps.23542 · Cited by 15 · see citing works
Roles of Glycogen Synthase Kinase-3 in Alzheimer's Disease: From Pathology to Treatment Target
Liu, H., Leu, S., & Chuang, D. (2012) · Journal of Experimental & Clinical Medicine · doi:10.1016/j.jecm.2012.04.001 · Cited by 9 · see citing works
Food for Your Mind? The Effect of Tyrosine on Selective Attention
Frings, C., Domes, G., Friehs, M. A., Geissler, C. F., & Schneider, K. (2019) · Journal of Cognitive Enhancement · doi:10.1007/s41465-019-00146-3 · Cited by 7 · see citing works
de Hoyos-Alonso, M. C., Tapias-Merino, E., Barros, C. M. M., Sánchez-Martínez, M., & Otero, Á. (2014) · Neurología · doi:10.1016/j.nrl.2014.02.007 · Cited by 6 · see citing works
Wimo, A. B., Gaudig, M., Schäuble, B., & Jedenius, E. (2012) · Journal of Medical Economics · doi:10.3111/13696998.2012.680554 · Cited by 6 · see citing works
Neuropsicología clínica en perspectiva: retos futuros basados en desarrollos presentes
Verdejo‐García, A., & Ustárroz, J. T. (2012) · Revista de Neurología · doi:10.33588/rn.5403.2011499 · Cited by 5 · see citing works
Ku, L. E., & Pai, M. (2014) · International Psychogeriatrics · doi:10.1017/s1041610213002603 · Cited by 5 · see citing works
Gilligan, A. M., Malone, D. C., Warholak, T. L., & Armstrong, E. P. (2013) · Advances in Alzheimer s Disease · doi:10.4236/aad.2013.23011 · Cited by 5 · see citing works
Phytochemicals in Life Style Associated Human Diseases
Verma, H., Gangwar, P., Yadav, A., Yadav, B., Rao, R., Kumari, S., Kaur, S., Dhiman, M., & Mantha, A. K. (2025) · Advances in Science, Technology & Innovation/Advances in science, technology & innovation · doi:10.1007/978-3-031-80973-6_19 · Cited by 3 · see citing works
Saini, M., Rohilla, S., & Kumar, R. (2025) · Current Aging Science · doi:10.2174/0118746098376646250715094707 · Cited by 3 · see citing works
Lyseng-Williamson, K. A., & McKeage, K. (2012) · Drugs & Aging · doi:10.1007/s40266-012-0041-0 · Cited by 3 · see citing works
Are we Providing the Best Possible Care for Dementia Patients?
Borisovskaya, A., Chen, K., & Soo Borson, B. (2015) · Neurodegenerative Disease Management · doi:10.2217/nmt.15.9 · Cited by 3 · see citing works
de Hoyos-Alonso, M. C., Tapias-Merino, E., Barros, C. M. M., Sánchez-Martínez, M., & Otero, Á. (2015) · Neurología (English Edition) · doi:10.1016/j.nrleng.2014.02.005 · Cited by 3 · see citing works
In-vitro acetylcholine release is not a straightforward model to study hippocampal 5-HT4 receptors
de Vin, F., Maeyer, J. H. D., & Lefebvre, R. A. (2011) · Neuroreport · doi:10.1097/wnr.0b013e32834c7fd4 · Cited by 3 · see citing works
¿Cuándo suspender el tratamiento farmacológico específico en el Alzheimer?
de Tuero, G. C., Pousa, S. L., & Franch, J. V. (2011) · Atención Primaria · doi:10.1016/j.aprim.2011.09.001 · Cited by 2 · see citing works
Barriers to evidence-based prescribing in Alzheimer's disease
Ballard, C. G. (2013) · British Journal of Mental Health Nursing · doi:10.12968/bjmh.2013.2.1.16 · Cited by 2 · see citing works
Cognitive enhancers provide some benefits in patients with moderate to severe Alzheimer’s disease
(2011) · Drugs & Therapy Perspectives · doi:10.1007/bf03257129 · Cited by 2 · see citing works
Saleh, A. Y., Saputra, D. A. Y., Valentina, R., & Susanto, T. D. (2025) · F1000Research · doi:10.12688/f1000research.160416.3 · Cited by 1 · see citing works
Jiang, X., Lv, G., Xiong, X., Yuan, J., & Lu, Z. K. (2026) · Journal of Alzheimer s Disease · doi:10.1177/13872877261430376 · Cited by 1 · see citing works
Saleh, A. Y., Saputra, D. A. Y., Valentina, R., & Susanto, T. D. (2025) · F1000Research · doi:10.12688/f1000research.160416.1 · Cited by 1 · see citing works
Advances in Alzheimer’s Disease Management
Gauthier, S. G., & Rosa‐Neto, P. (2012) · doi:10.2217/9781780840840 · Cited by 1 · see citing works
Modeling cost–effectiveness of pharmaceuticals in Alzheimer's disease
Oremus, M., & Tarride, J. (2012) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.12.21
Psychopharmacologic Agents to Enhance Cognition in Alzheimer’s Disease
Atri, A., & Stern, T. A. (2015) · Psychiatric Annals · doi:10.3928/00485713-20150626-07
Available symptomatic antidementia drugs
Thibodeau, M., & Massoud, F. (2012) · doi:10.2217/ebo.11.325
Lipton, A. M., & Marshall, C. D. (2012) · Springer eBooks · doi:10.1007/978-1-4614-4163-2_8
(2010) · Pharmaceutical Medicine · doi:10.1007/bf03256839
BHAGAT, A. N., & BHOYAR, S. (2026) · Asian Journal of Pharmaceutical and Clinical Research · doi:10.22159/ajpcr.2026v19i8.58645
- Authors
- Cappell, J., Herrmann, N., Cornish, S., & Lanctôt, K. L.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Lanctôt, Krista L.
- Venue
- CNS Drugs
- Published
- 2010-11
- Volume
- 24
- Issue
- 11
- Pages
- 909-927
- ISSN
- 1172-7047 (ISSN-L)
- OpenAlex
- W2041110161
- Cited by
- 57
- References
- 112
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 1 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 5 · 2014: 3 · 2013: 8 · 2012: 12
- FWCI
- 1.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CNS Drugs (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- H. Lundbeck A/S
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Keywords
- Alzheimer's disease, nootropic drugs, cholinesterase inhibitors, donepezil, rivastigmine, galantamine, memantine, NMDA receptor antagonists, cost-effectiveness, economic burden, caregiver costs, institutionalization, disease progression, resource utilization (health care)
- MeSH terms
- Alzheimer Disease, Clinical Trials as Topic, Cost-Benefit Analysis, Drug Therapy, Combination, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Health Care Costs, Disease Progression, Nootropic Agents
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