Cost effectiveness of memantine in Alzheimer's disease in the UK.
OBJECTIVE
This analysis assesses the cost-effectiveness of memantine for the treatment of moderate-to-severe Alzheimer's disease (AD) in the UK.


METHODS
This cost-utility analysis was based on a Markov model. The model simulated 5-year progress of patients with AD until they need full-time care (FTC), defined as a patient becoming either dependent or institutionalised. Transition probabilities were based on a predictive equation, derived from the London and South-East Region epidemiological study. Resource use, utilities and mortality were obtained from the same study. Memantine efficacy was based on a meta-analysis of six large trials. The model compared memantine to its alternative in the UK, i.e. no pharmacological treatment or background therapy with acetylcholinesterase inhibitors.


RESULTS
Memantine was found to delay the need to FTC by 6 weeks compared with current practice in the UK. It was associated with increased quality-adjusted life-years and cost savings to the healthcare system (probability of this outcome was 96%). The projections were made assuming that benefits from the 6-month treatment were sustained over time, which is regarded as the main limitation. The model underwent extensive sensitivity analyses, which confirmed the base-case findings.


CONCLUSIONS
The model suggests that memantine delays the need for FTC and decreases cost. It can be regarded as a cost-effective choice in the management of moderate and severe AD.
Rive
B
B
Université Claude Bernard Lyon 1, France.
Grishchenko
M
M
Guilhaume-Goulant
C
C
Katona
C
C
Livingston
G
G
Lamure
M
M
Toumi
M
M
François
C
C
D000544:Alzheimer Disease / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D015259:Dopamine Agents / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008390:Markov Chains; D008559:Memantine / Q000191:economics* / Q000627:therapeutic use*; D015201:Meta-Analysis as Topic; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D006113:United Kingdom
D015259:Dopamine Agents; D008559:Memantine