title: Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease.
abstract: Available treatments for Alzheimer's disease (AD) need to be evaluated in order to determine whether the clinical benefits justify their additional costs. This study evaluated the cost-effectiveness of donepezil treatment compared with no-drug treatment of mild and moderate AD from the perspective of society and the health care system in Spain. A Markov model was designed to simulate the natural history of a cohort of patients with mild and moderate AD. Monthly transition probabilities were estimated from the international literature and donepezil clinical trials. Direct medical and non-medical costs and utilities were derived from Spanish studies. Local data on tolerance and medication withdrawal rates were incorporated into the model. Incremental cost-effectiveness ratios for a range of realistic treatment options were calculated. A probabilistic sensitivity analysis was carried out using a Monte Carlo approach with 10,000 iterations. In the baseline scenario (24 months, patients initially with mild AD) incremental cost-effectiveness for direct medical costs was 20,353 euro/QALY. When all costs were taken into account, donepezil treatment was the dominant strategy. Incremental cost-effectiveness ratios vary according to the selected perspective. For the baseline scenario, donepezil treatment is cost-effective with a probability of 95% for a threshold efficiency of 25,000 euro/QALY.
authors.affiliation: Evaluation and Planning Unit, Canary Islands Health Service, Spain. jlopbas@gobiernodecanarias.org
authors.forename: Julio
authors.initials: J
authors.lastname: López-Bastida
authors.forename: Warren
authors.initials: W
authors.lastname: Hart
authors.forename: Lidia
authors.initials: L
authors.lastname: García-Pérez
authors.forename: Renata
authors.initials: R
authors.lastname: Linertová
mesh_terms: D000544:Alzheimer Disease / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D002800:Cholinesterase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000379:methods; D018450:Disease Progression; D000077265:Donepezil; D006801:Humans; D007189:Indans / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D010880:Piperidines / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil