Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer's disease in Germany using discrete event simulation.
BACKGROUND
Previous cost-effectiveness studies of cholinesterase inhibitors have modeled Alzheimer's disease (AD) progression and treatment effects through single or global severity measures, or progression to "Full Time Care". This analysis evaluates the cost-effectiveness of donepezil versus memantine or no treatment in Germany by considering correlated changes in cognition, behavior and function.


METHODS
Rates of change were modeled using trial and registry-based patient level data. A discrete event simulation projected outcomes for three identical patient groups: donepezil 10 mg, memantine 20 mg and no therapy. Patient mix, mortality and costs were developed using Germany-specific sources.


RESULTS
Treatment of patients with mild to moderately severe AD with donepezil compared to no treatment was associated with 0.13 QALYs gained per patient, and 0.01 QALYs gained per caregiver and resulted in average savings of €7,007 and €9,893 per patient from the healthcare system and societal perspectives, respectively. In patients with moderate to moderately-severe AD, donepezil compared to memantine resulted in QALY gains averaging 0.01 per patient, and savings averaging €1,960 and €2,825 from the healthcare system and societal perspective, respectively.In probabilistic sensitivity analyses, donepezil dominated no treatment in most replications and memantine in over 70% of the replications. Donepezil leads to savings in 95% of replications versus memantine.


CONCLUSIONS
Donepezil is highly cost-effective in patients with AD in Germany, leading to improvements in health outcomes and substantial savings compared to no treatment. This holds across a variety of sensitivity analyses.
B214 Baquba Building, Conington Road, SE13 7FF London, UK.
Susanne
S
Hartz
Denis
D
Getsios
Sunning
S
Tao
Steve
S
Blume
Grant
G
Maclaine
D000544:Alzheimer Disease / Q000188:drug therapy* / Q000191:economics; D002800:Cholinesterase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000077265:Donepezil; D015259:Dopamine Agents / Q000191:economics* / Q000627:therapeutic use; D005858:Germany; D006801:Humans; D007189:Indans / Q000191:economics* / Q000627:therapeutic use; D008559:Memantine / Q000191:economics* / Q000627:therapeutic use; D010880:Piperidines / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years
D002800:Cholinesterase Inhibitors; D015259:Dopamine Agents; D007189:Indans; D010880:Piperidines; D000077265:Donepezil; D008559:Memantine