Comparative Value of Cholinesterase Inhibitors and Memantine in Persons with Moderate-to-Severe Alzheimer’s Disease in the United States: A Cost-Effectiveness Analysis1
| Autor: | Ismaeel Yunusa, Tewodros Eguale, Saud Alsahali, A. Rane |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Research Report
medicine.medical_specialty cholinesterase inhibitors Transdermal patch Disease Internal medicine medicine Galantamine quality-adjusted life years Donepezil health care economics and organizations Rivastigmine business.industry General Neuroscience cost-effectiveness analysis Memantine Cost-effectiveness analysis donepezil Quality-adjusted life year Psychiatry and Mental health Clinical Psychology rivastigmine memantine Geriatrics and Gerontology business Alzheimer’s disease medicine.drug |
| Zdroj: | Journal of Alzheimer's Disease Reports |
| ISSN: | 2542-4823 |
| DOI: | 10.3233/adr-210307 |
| Popis: | Background: Pharmacological treatment of Alzheimer’s disease (AD) involves symptomatic improvement of cognition using cholinesterase inhibitors (ChEIs) and memantine. The cost-effectiveness of these medications will guide decision-makers in making judicious use of scarce healthcare resources, particularly during the advanced disease stages. Objective: To evaluate the cost-effectiveness of ChEIs, memantine, and ChEI-memantine combinations in persons with moderate-to-severe AD from the US healthcare perspective. Methods: This pharmacoeconomic evaluation study used a state-transition Markov cohort model to simulate the costs and effectiveness of ChEI-memantine combinations compared with monotherapies of ChEI (donepezil, galantamine and rivastigmine) and memantine in persons with moderate-to-severe AD over a lifetime horizon with a 1-year cycle length. We estimated expected quality-adjusted life-years (QALYs), costs (in 2020 $US), net monetary benefits, and incremental cost-effectiveness ratios (ICERs). We discounted future costs and QALYs at the rate of 3%. Results: In this study, donepezil monotherapy, galantamine-memantine combination, and rivastigmine transdermal patch formed the cost-effectiveness frontier. Findings suggests that rivastigmine transdermal patch is the optimal treatment strategy at a willingness-to-pay (WTP) threshold of $150,000/QALY (ICER = $93,307/QALY [versus donepezil monotherapy]). Results across subgroups by age and sex also suggest that the rivastigmine transdermal patch is the optimal treatment strategy with the highest net benefit. Conclusion: From the US healthcare perspective, we found that, for persons with moderate-to-severe AD at a WTP threshold of $150,000/QALY, the rivastigmine transdermal patch is the most cost-effective pharmacological treatment option. Given that the transdermal patch is a preferred route of administration for persons with AD and their caregivers due to its convenience, our findings provide additional incentives for its use. |
| Databáze: | OpenAIRE |
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