Assessment of Health Economics in Alzheimer's Disease (AHEAD): treatment with galantamine in Sweden.
BACKGROUND
Like other developed countries with aging populations, Sweden is expecting large increases in the prevalence of Alzheimer's disease and corresponding escalations in the cost of care for patients with this disease. Galantamine, a new acetylcholinesterase inhibitor and nicotinic modulator, has proved effective in managing patients with Alzheimer's disease in clinical trials.


OBJECTIVE
To estimate the long-term health and economic impact of galantamine from the perspective of the public health payer in Sweden.


METHODS
The Assessment of Health Economics in Alzheimer's Disease (AHEAD) model compares galantamine treatment with no pharmacologic treatment. It consists of a module based on trial data followed by a projection module that uses the trial results to predict the time until patients require full-time care (FTC) or until their death. Forecasts were made for up to 10 years. The model was customised to Sweden by using Swedish resource use profiles obtained from the literature.


RESULTS
Galantamine is predicted to reduce the time patients require FTC by almost 10%. Approximately 5.6 patients with mild-to-moderate disease would need to be treated to avoid one year of FTC. This would result in savings averaging 27 436 Swedish kronas (SEK) [3131 euros (EUR)] per patient over 10 years (1998 values). To avoid one year of FTC, 3.9 patients with moderate disease would need to be treated, with savings averaging SEK49 019 (EUR 5594) per patient over 10.5 years. Sensitivity analyses of key parameters, such as proportion of patients needing FTC treated in the community, cost of care in an institution, cost of FTC care in the community, the price of galantamine, and the discount rate, found savings with galantamine would occur under most circumstances.


CONCLUSIONS
Galantamine can increase the time before patients require FTC, and may also lead to savings as treatment costs are offset by reductions in other healthcare expenditures and the costs associated with FTC.
Caro Research Institute, Concord, Massachusetts 01742, USA. fgarfield@caroresearch.com
Frances B
FB
Garfield
Denis
D
Getsios
J Jaime
JJ
Caro
Anders
A
Wimo
Bengt
B
Winblad
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D002986:Clinical Trials as Topic; D017281:Cost of Illness; D018450:Disease Progression; D016527:Drug Costs / Q000706:statistics & numerical data; D005702:Galantamine / Q000191:economics* / Q000627:therapeutic use*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics; D006302:Health Services Research; D006801:Humans; D007326:Institutionalization / Q000191:economics; D008134:Long-Term Care / Q000191:economics; D017059:Models, Econometric; D018697:Nootropic Agents / Q000191:economics* / Q000627:therapeutic use*; D011336:Probability; D012680:Sensitivity and Specificity; D013548:Sweden
D018697:Nootropic Agents; D005702:Galantamine