title: Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US.
abstract: OBJECTIVE
  This study evaluates the cost-effectiveness of memantine extended release (ER) as an add-on therapy to acetylcholinesterase inhibitor (AChEI) [combination therapy] for treatment of patients with moderate-to-severe Alzheimer's disease (AD) from both a healthcare payer and a societal perspective over 3 years when compared to AChEI monotherapy in the US.
  
  
  METHODS
  A phase III trial evaluated the efficacy and safety of memantine ER for treatment of AD patients taking an AChEI. The analysis assessed the long-term costs and health outcomes using an individual patient simulation in which AD progression is modeled in terms of cognition, behavior, and functioning changes. Input parameters are based on patient-level trial data, published literature, and publicly available data sources. Changes in anti-psychotic medication use are incorporated based on a published retrospective cohort study. Costs include drug acquisition and monitoring, total AD-related medical care, and informal care associated with caregiver time. Incremental cost-utility ratio (ICUR), life years, care time for caregiver, time in community and institution, time on anti-psychotics, time by disease severity, and time without severe symptoms are reported. Costs and health outcomes are discounted at 3% per annum.
  
  
  RESULTS
  Considering a societal perspective over 3 years, this analysis shows that memantine ER combined with an AChEI provides better clinical outcomes and lower costs than AChEI monotherapy. Discounted average savings were estimated at $18,355 and $20,947 per patient and quality-adjusted life-years (QALYs) increased by an average of 0.12 and 0.13 from a societal and healthcare payer perspective, respectively. Patients on combination therapy spent an average of 4 months longer living at home and spend less time in moderate-severe and severe stages of the disease.
  
  
  CONCLUSIONS
  Combination therapy for patients with moderate-to-severe AD is a cost-effective treatment compared to AChEI monotherapy in the US.
authors.affiliation: a a Evidera , Montreal , QC , Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Saint-Laurent Thibault
authors.affiliation: b b Evidera , Lexington , MA , USA.
authors.forename: Ipek
authors.initials: I
authors.lastname: Özer Stillman
authors.affiliation: c c AstraZeneca , Gaithersburg , MD , USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chen
authors.affiliation: b b Evidera , Lexington , MA , USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Getsios
authors.affiliation: a a Evidera , Montreal , QC , Canada.
authors.forename: Irina
authors.initials: I
authors.lastname: Proskorovsky
authors.affiliation: b b Evidera , Lexington , MA , USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Hernandez
authors.affiliation: d d Forest Research Institute, LLC, an affiliate of Actavis, Inc. , Jersey City , NJ , USA.
authors.forename: Shailja
authors.initials: S
authors.lastname: Dixit
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000191:economics*; D014150:Antipsychotic Agents / Q000008:administration & dosage; D017028:Caregivers / Q000191:economics / Q000706:statistics & numerical data; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008559:Memantine / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D003692:Delayed-Action Preparations; D008559:Memantine
keywords: Acetylcholinesterase inhibitors; Alzheimer’s disease; Cost; Cost-benefit analysis; Dementia; Effectiveness; Memantine