Economic evaluation of the impact of memantine on time to nursing home admission in the treatment of Alzheimer disease.
OBJECTIVE
An observational study showed that combining memantine with a cholinesterase inhibitor (ChEI) treatment significantly delayed admission to nursing homes in patients with Alzheimer disease (AD). Our study aimed to evaluate the economic impact of the concomitant use of memantine and a ChEI, compared with a ChEI alone, in a Canadian population of patients with AD.


METHODS
A cost-utility analysis using a Markov model during a 7-year time horizon was performed according to a societal and Canadian health care system perspective. The Markov model includes the following states: noninstitutionalized, institutionalized, and deceased. The model includes transition probabilities for institutionalization and death, adjusted with mortality rates specific to AD. Utilities associated with institutionalization and noninstitutionalization were included. For the health care system perspective, costs of medication as well as costs of care provided in the community and in nursing homes were considered. For the societal perspective, costs of direct care and supervision provided by caregivers were added.


RESULTS
From both perspectives, the concomitant use of a ChEI and memantine is a dominant strategy, compared with the use of a ChEI alone. On a per patient basis, there was a gain of 0.26 quality-adjusted life years with the treatment including memantine and cost decreases of Can$21 391 and Can$30 512, respectively, for the societal and health care system perspective.


CONCLUSIONS
This economic evaluation indicates that institutionalization is the largest cost component in AD management and that the use of memantine, combined with a ChEI, to treat AD is a cost-effective alternative, compared with the use of a ChEI alone.
University of Montreal, Quebec. jean.lachaine@umontreal.ca
Jean
J
Lachaine
Catherine
C
Beauchemin
Mark
M
Legault
Sébastien
S
Bineau
D000544:Alzheimer Disease / Q000188:drug therapy* / Q000191:economics; D002170:Canada; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D008559:Memantine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D010343:Patient Admission; D013997:Time Factors
D002800:Cholinesterase Inhibitors; D018696:Neuroprotective Agents; D008559:Memantine