title: Rational choice of cholinesterase inhibitor for the treatment of Alzheimer's disease in Canada: a comparative economic analysis.
abstract: BACKGROUND
  Cholinesterase inhibitors, such as galantamine, donepezil and rivastigmine are approved for symptomatic treatment of Alzheimer's Disease (AD) in Canada. In making choices amongst these drugs, one should consider their clinical merits and their economic implications.
  
  
  METHODS
  Each drug's short-term efficacy was estimated based on independent Cochrane reviews of the clinical trials. Long-term clinical and economic outcomes were estimated using the Assessment of Health Economics in Alzheimer's Disease (AHEAD) model.
  
  
  RESULTS
  While all treatments reduced the need for full-time care, only galantamine and donepezil 10 mg reduced the overall management costs of AD patients. The somewhat greater cognitive effect provided over six months by galantamine leads to the longest estimated delay before full-time care is required and, consequently to lower overall costs, with savings estimated at between 323 dollars and 4,246 dollars.
  
  
  CONCLUSIONS
  Although there is uncertainty in estimated results, the best information currently available suggests that the first choice for treatment of AD should be galantamine. These results should be interpreted with caution, however, as results are not based on direct comparisons among the drugs and the differences emerging from meta-analyses of the trials are relatively small.
authors.affiliation: Caro Research Institute, Concord, MA 01742, USA. jcaro@caroresearch.com
authors.forename: Jaime
authors.initials: J
authors.lastname: Caro
authors.forename: Denis
authors.initials: D
authors.lastname: Getsios
authors.forename: Kristen
authors.initials: K
authors.lastname: Migliaccio-Walle
authors.forename: Jack
authors.initials: J
authors.lastname: Ishak
authors.forename: Wissam
authors.initials: W
authors.lastname: El-Hadi