Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease.
BACKGROUND
(Acetyl-)cholinesterase (ChE) inhibitors have been approved for the treatment of mild to moderate Alzheimer's disease (AD). However, use of ChE inhibitors is limited by budget constraints and disincentives on the side of health insurances and nursing care insurances.


OBJECTIVE
To analyse under what conditions the application of the acetylcholinesterase inhibitor donepezil is favourable for the treatment of patients with AD from the perspective of health insurance and nursing care insurance companies in Germany, taking into account factors such as start and duration of treatment, duration of follow-up, drug costs, internalization of opportunity costs and varying mortality and efficacy rates.


METHODS
Transition probabilities from a Swedish study and German cost data for donepezil were merged in a Markov model to follow a cohort of patients over a period of 5-10 years. We defined a base case with 1 year treatment and follow-up over 5 years and varied treatment length, follow-up interval and cost factors in sensitivity analyses.


RESULTS
In the base case, the ChE inhibitor donepezil did not lead to cost savings but to a cost-effective outcome on side of health insurances and nursing care insurances. Early treatment of AD and internalization of opportunity costs (caring time devoted to patients) led to less costs per quality adjusted life years gained. However, results are very sensitive with respect to varying mortality and efficacy rates.


CONCLUSIONS
The application of donepezil may be cost-effective, but considerable uncertainties remain. Moreover, the way the reimbursement system in Germany is presently arranged does not support the application of ChE inhibitors.
Teipel
Stefan J
SJ
Alzheimer Memorial Center and Geriatric Psychiatry Branch, Dementia and Neuroimaging Section, Department of Psychiatry, Ludwig-Maximilian University, Nussbaumstr.7, Munich, 80336, Germany. stefan.teipel@med.uni-muenchen.de
Ewers
Michael
M
Reisig
Veronika
V
Schweikert
Bernd
B
Hampel
Harald
H
Happich
Michael
M
D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003627:Data Interpretation, Statistical; D000077265:Donepezil; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006305:Health Status Indicators; D006801:Humans; D007189:Indans / Q000191:economics* / Q000627:therapeutic use*; D008134:Long-Term Care; D008297:Male; D008390:Markov Chains; D018697:Nootropic Agents / Q000191:economics* / Q000627:therapeutic use*; D010347:Patient Care Planning / Q000191:economics; D010880:Piperidines / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years
D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil