Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer's disease in Taiwan.
BACKGROUND
Donepezil is a drug used for treatment in patients with Alzheimer's disease (AD). Information regarding the cost-effectiveness of this medication was previously rare in Asia. We used techniques of decision analysis and economic evaluation in conjunction with available local epidemiological and clinical data on costs of mild to moderate AD to assess the cost-effectiveness of donepezil in Taiwan.


METHODS
A four-state Markov model was built to simulate the disease progression of AD patients. Local transition probabilities and costs of different stages were from the studies published earlier.


RESULTS
Over a 5-year span, donepezil treatment for mild or moderate AD patients is predicted to result in the gain of 0.505 QALYs when comparing to usual care, while at the same time reducing the cost by US$7,691. The incremental cost was US$3,647 from the payer perspective; thus, the incremental cost-effectiveness ratio was estimated to be US$7,226 when considering only the medical expenditures.


CONCLUSIONS
Under some assumptions, donepezil treatment might be a cost saving strategy for mild to moderate AD patients in Taiwan from a societal perspective. It is inconclusive from the payer's part since we still lack a consensus for judging the cost-effectiveness of a new health care technology.
Fuh
Jong-Ling
JL
Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan. jlfuh@vghtpe.gov.tw
Wang
Shuu-Jiun
SJ
D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000191:economics*; D002800:Cholinesterase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D018450:Disease Progression; D000077265:Donepezil; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007189:Indans / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018697:Nootropic Agents / Q000191:economics / Q000627:therapeutic use; D010880:Piperidines / Q000191:economics* / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013624:Taiwan; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors; D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil