title: Economic impact of introducing propentofylline for the treatment of dementia in Sweden.
abstract: The purpose of this study was to estimate the impact of the introduction of propentofylline, a glial-cell modulator with neuroprotective properties, on the costs of dementia care in Sweden. To estimate the clinical effects of propentofylline treatment on dementia, we conducted a meta-analysis of four double-masked, placebo-controlled, randomized clinical trials and a simulation in a cohort of 57,000 patients with Alzheimer's disease (AD) or vascular dementia (VaD). This cohort represented the fraction of the total AD and VaD population in Sweden with mild-to-moderate disease, the target population for propentofylline treatment. The rate of progression of dementia was expressed in terms of the annual rate of change in score on the Mini-Mental State Examination (MMSE). The costs of care were estimated on the basis of a prospective population-based study. A regression model was used to quantify the costs of dementia care as a function of MMSE score. The estimates obtained were used to calculate and compare the costs of dementia care until death, with or without propentofylline treatment. The sensitivity of the results to a variety of model assumptions was also assessed. The total gross cost for 9 years under the current treatment strategy was SEK (Swedish kronor) 168.06 billion. Including propentofylline in the treatment strategy yielded net savings of SEK 0.8 billion, since the savings in the cost of patient care outweighed the drug acquisition costs. Over 9 years, this saving represents 3.8% of the costs of dementia care in the target population (MMSE score, 15-25 points) and 0.5% of the costs in the total AD and VaD population. The annual savings per patient ranged from SEK 5517 to 6387 during the first 4 years of propentofylline treatment. If an extended neuroprotective effect of propentofylline is assumed, savings increase to SEK 1.6 billion, equivalent to 7.6% of total care costs in the target population and 1.0% in the total population. Savings increase to SEK 14.6 billion if the extended neuro-protective effect is assumed to be effective in an extended target population (MMSE score, 0-25 points) without increased survival. In the sensitivity analysis, most scenarios yielded benefits in favor of propentofylline treatment. The clinical effects of propentofylline translate into meaningful economic effects. The drug acquisition costs are more than offset by the savings achieved in the cost of care. The inclusion of a broader range of outcomes may increase these savings.
authors.affiliation: Research Unit, Primary Health Care, Nordanstig, Bergsjö, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wimo
authors.forename: E
authors.initials: E
authors.lastname: Witthaus
authors.forename: M
authors.initials: M
authors.lastname: Rother
authors.forename: B
authors.initials: B
authors.lastname: Winblad
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy / Q000523:psychology; D003365:Costs and Cost Analysis; D003704:Dementia / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D015140:Dementia, Vascular / Q000188:drug therapy / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D018803:Models, Economic; D018696:Neuroprotective Agents / Q000191:economics* / Q000627:therapeutic use*; D013548:Sweden; D014970:Xanthines / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D018696:Neuroprotective Agents; D014970:Xanthines; C032114:propentofylline