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Long-term cost-effectiveness of donepezil for the treatment of Alzheimer’s disease

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European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Background

(Acetyl-)cholinesterase (ChE) inhibitors have been approved for the treatment of mild to moderate Alzheimer’s disease (AD). However, use of ChE inhibitors is limited by budget constraints and disincentives on the side of health insurances and nursing care insurances.

Objective

To analyse under what conditions the application of the acetylcholinesterase inhibitor donepezil is favourable for the treatment of patients with AD from the perspective of health insurance and nursing care insurance companies in Germany, taking into account factors such as start and duration of treatment, duration of follow-up, drug costs, internalization of opportunity costs and varying mortality and efficacy rates.

Methods

Transition probabilities from a Swedish study and German cost data for donepezil were merged in a Markov model to follow a cohort of patients over a period of 5–10 years. We defined a base case with 1 year treatment and follow-up over 5 years and varied treatment length, follow-up interval and cost factors in sensitivity analyses.

Results

In the base case, the ChE inhibitor donepezil did not lead to cost savings but to a cost-effective outcome on side of health insurances and nursing care insurances. Early treatment of AD and internalization of opportunity costs (caring time devoted to patients) led to less costs per quality adjusted life years gained. However, results are very sensitive with respect to varying mortality and efficacy rates.

Conclusion

The application of donepezil may be cost-effective, but considerable uncertainties remain. Moreover, the way the reimbursement system in Germany is presently arranged does not support the application of ChE inhibitors.

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Notes

  1. The structure of the model in DATA PRO is available upon request

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Acknowledgement

We thank Johannes F. Hallauer of the Charité University Hospital and Peter J. Neumann of the Harvard Center for Risk Analysis for helpful comments. Financial support for this study was provided by the German Centre of Gerontology, Office of the Committee of Experts to the 4th Report on the Elderly, Manfred-von-Richthofen-Str.2, 12101 Berlin, Germany, to M.H. There are no competing interests.

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Authors and Affiliations

  1. Alzheimer Memorial Center and Geriatric Psychiatry Branch, Dementia and Neuroimaging Section, Department of Psychiatry, Ludwig-Maximilian University, Nussbaumstr.7, Munich, 80336, Germany

    Stefan J. Teipel MD, Michael Ewers MD & Harald Hampel MD

  2. GSF – National Research Center for Environment and Health, Institute for Health Economics and Health Care Management, Neuherberg, Germany

    Veronika Reisig MD, Bernd Schweikert MSc & Michael Happich PhD

Authors
  1. Stefan J. Teipel MD
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  2. Michael Ewers MD
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  3. Veronika Reisig MD
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  5. Harald Hampel MD
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Correspondence to Stefan J. Teipel MD.

Appendix

Appendix

Table A-1 Overview of variables in the base case
Full size table

Formula A-1: Cost calculations for different severity grades of Alzheimer disease.

Cost[i] = DrugCost + InCare[i] × InstGrad[i] + [OutCare[i] + FamCare[i] × Remuneration] × [1 − InstGrad[i]]

  • DrugCost = Acquisition costs of donepezil within a year of therapy

  • [i] = Severity grade

  • InCare [i] = Direct inpatient costs within a year with respect to severity [i]

  • OutCare[i] = Direct outpatient costs within a year with respect to severity [i]

  • Fam Care [I] = Time devoted to care by families within a year

  • Remuneration = Hypothetical wage rate for care

  • InstGrad [i] = Degree of institutionalization with respect to severity [i]

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Teipel, S.J., Ewers, M., Reisig, V. et al. Long-term cost-effectiveness of donepezil for the treatment of Alzheimer’s disease. Eur Arch Psychiatry Clin Neurosc 257, 330–336 (2007). https://doi.org/10.1007/s00406-007-0727-1

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  • DOI: https://doi.org/10.1007/s00406-007-0727-1

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