Cost-effectiveness of memantine for moderate to severe Alzheimer's disease in Sweden.
BACKGROUND
Alzheimer's disease entails enormous costs for society and impairs quality of life for patients and caregivers.


OBJECTIVE
This study estimated the cost-effectiveness of memantine in the treatment of patients with moderately severe to severe cognitive impairment from Alzheimer's disease in Sweden.


METHODS
The study was based on published data from several sources, including a randomized controlled trial of memantine versus placebo and a longitudinal observational study of Alzheimer's disease patients in Sweden. Costs were estimated from the public payer's perspective, including direct costs but excluding costs of informal care, and resource utilization data were taken from the observational study. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from treatment with the use of previously published utility weights. A Markov simulation model was constructed, incorporating the effect of treatment on cognitive function, physical dependence related to activities of daily living, and institutionalization. Costs and effects for treated and untreated patients were estimated for 5 years (10 cycles). In the base-case analysis, treatment costs were added for 2 years, but the effect on transition probabilities was applied only for the first year of treatment.


RESULTS
Compared with no treatment, memantine treatment was predicted to be associated with lower costs of care, longer time to dependence and institutionalization, and gains in QALYs. Treatment was estimated to decrease formal care costs by 123,600 Swedish kronor (SEK) and, after taking into account the cost of memantine, to lead to net cost savings of 100,528 SEK per patient. Treated patients gained 0.148 QALY over the 5-year simulation.


CONCLUSIONS
From a public payer's perspective, the observed effect of memantine on cognitive and physical function is predicted to translate into economic benefits that offset the added treatment cost. Treatment is also predicted to delay institutionalization, improve independence, and increase QALYs.
Jönsson
Linus
L
Stockholm Health Economics, Stockholm, Sweden. linus.j@healtheconomics.se
D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy / Q000191:economics*; D003071:Cognition / Q000187:drug effects; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D015259:Dopamine Agents / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D007326:Institutionalization / Q000191:economics; D008390:Markov Chains; D008559:Memantine / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013548:Sweden
D015259:Dopamine Agents; D008559:Memantine