Impact of rivastigmine on costs and on time spent in caregiving for families of patients with Alzheimer's disease.
BACKGROUND
Alzheimer's disease (AD) places a significant burden on health care systems worldwide. As new treatments are developed, their cost-effectiveness is often assessed to help health care professionals make informed decisions. In addition to the more common practice of assessing direct medical costs, indirect costs, including time spent in caregiving, should be evaluated.


METHODS
This study examined the potential effects of the dual cholinesterase inhibitor rivastigmine (Exelon) on caregivers of patients with AD. Results from two 26-week, placebo-controlled trials have demonstrated the clinically relevant and statistically significant efficacy of rivastigmine (6-12 mg/day) compared to placebo, on cognition, activities of daily living, and global functioning. By delaying progression of AD, significant savings in caregiver burden are anticipated, as measured by time spent caregiving and its related costs. Data collected in a prospective, observational study of AD patients and their caregivers were used to establish the relationship between disease severity (based on Mini-Mental State Examination [MMSE] score) and time spent caregiving (according to the 5-item Caregivers Activity Survey score). A significant correlation was observed between the two scores (N = 43, r = -.56, p < .0001), demonstrating that more time for supervision from caregivers is required as the disease progresses. This finding was used to estimate the reduced caregiver burden resulting from the delay in disease progression that was demonstrated with use of rivastigmine.


RESULTS
Over a 2-year period, the reduction in time spent in caregiving reached 691 hours for caregivers of patients with mild AD (MMSE score 21-30), resulting in a total savings of approximately 11,253 dollars. Treatment of patients with moderately severe AD was also evaluated. The trend was similar but the impact was less, suggesting an economic benefit to early therapy.


CONCLUSIONS
Early diagnosis and a pharmacologic intervention that allows the patients to remain at home longer by delaying disease progression would have a beneficial impact on patients, caregivers, and payers, and should therefore be encouraged through initiatives designed to identify and treat patients early in the course of disease.
Marin
Deborah
D
Mount Sinai School of Medicine, New York, New York, USA.
Amaya
Karine
K
Casciano
Roman
R
Puder
Katherine L
KL
Casciano
Julian
J
Chang
Sobin
S
Snyder
Edward H
EH
Cheng
Isaac
I
Cuccia
Anthony J
AJ
D000203:Activities of Daily Living / Q000145:classification; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D002219:Carbamates / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D017028:Caregivers / Q000191:economics*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D017046:Cost Savings; D017281:Cost of Illness; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000191:economics; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009519:New York City; D048448:Phenylcarbamates; D011446:Prospective Studies; D011594:Psychometrics; D000068836:Rivastigmine
D002219:Carbamates; D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D000068836:Rivastigmine