Economic evaluation of galantamine in the treatment of mild to moderate Alzheimer's disease in the United States.
BACKGROUND
Alzheimer's disease (AD) is estimated to affect up to 11% of those aged > or =65 years in the United States, and the number of patients with AD is predicted to increase over the next few decades as the population ages. The substantial social and economic burden associated with AD is well established, with the cost of management increasing as the disease progresses.


OBJECTIVE
The aim of this study was to evaluate the economic impact of galantamine 16 and 24 mg/d relative to no pharmacologic treatment in the management of mild to moderate AD in the United States based on the concept of need for full-time care (FTC).


METHODS
Calculations were made using the Assessment of Health Economics in Alzheimer's Disease model, which applies predictive equations to estimate the need for FTC and the associated costs. The predictive equations were developed from longitudinal data on patients with AD. Inputs to the equations were derived by analyzing the data from 2 randomized, placebo-controlled, galantamine clinical trials. Resource use (from a payer perspective) was estimated from US clinical trial data, and costs were estimated from several US databases. Analyses were carried out over 10 years, and costs and benefits were discounted at 3%.


RESULTS
In the base case, 3.9 to 4.6 patients need to start treatment with galantamine to avoid 1 year of FTC, depending on dose. Treated patients spent 7% to 8% more time pre-FTC and 12% to 14% less time requiring FTC, resulting in savings of 2408 to 3601 US dollars. Time horizons below 3 years, very high discontinuation rates, or increased survival with galantamine reversed the savings. Conversely, limiting treatment to responders delayed FTC by 6 to 7 months, with savings of approximately 9097 to 11,578 US dollars.


CONCLUSIONS
These results suggest that use of galantamine in patients with AD in the United States could reduce the use of costly resources such as formal home care and nursing homes, leading to cost savings over time.
Migliaccio-Walle
Kristen
K
Caro Research Institute, Concord, Massachusetts 01742, USA.
Getsios
Denis
D
Caro
J Jaime
JJ
Ishak
Khajak J
KJ
O'Brien
Judith A
JA
Papadopoulos
George
G
D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000191:economics; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D017046:Cost Savings; D004305:Dose-Response Relationship, Drug; D005260:Female; D005702:Galantamine / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D018803:Models, Economic; D009735:Nursing Homes / Q000191:economics; D005791:Patient Care / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014481:United States
D002800:Cholinesterase Inhibitors; D005702:Galantamine