| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Program on the Economic Evaluation of Medical Technology (Drs. Neumann, Kuntz, and Weinstein, and S.S. Araki, S.B. Duff, and P.A. Goldman), Center for Risk Analysis, Harvard School of Public Health, Boston, MA; Cambridge Hospital (Dr. Hermann), Cambridge, MA; Harvard Medical School (Drs. Hermann, Kuntz, and Weinstein, and P.A. Berenbaum), Boston, MA; Covance Health Economics and Outcomes Services (S.B. Duff), Washington, DC; Project HOPE Center for Health Affairs (Dr. Leon), Bethesda, MD; and Partners HealthCare Systems (L.W. Williams), Boston, MA.
Address correspondence and reprint requests to Dr. Peter J. Neumann, Harvard School of Public Health, 718 Huntington Ave., 2nd Floor, Boston, MA 02115; e-mail: pneumann{at}hsph.harvard.edu
OBJECTIVE: To demonstrate the use of cost-effectiveness analysis to assess the economic impact of donepezil in the treatment of mild or moderate AD.
BACKGROUND: Cost-effectiveness analyses show the relationship between resources used (costs) and health benefits achieved (effects) for an intervention compared with an alternative strategy.
METHODS: We developed a model to estimate the incremental cost-effectiveness of donepezil compared with no treatment. We determined costs per quality-adjusted life-years gained, a measurement that enhances the comparability of diverse studies. The model projects the progression of AD patients into more severe disease stages and into nursing homes. Data from a randomized clinical trial of donepezil were used to assess the drug’s impact on the 6-week probabilities of progression. Data on the costs and health-related quality of life associated with different disease stages and settings were taken from published estimates and our companion cross-sectional study, respectively.
RESULTS: Donepezil costs are partially offset by a reduction in the costs of care due to enhancement in cognitive functioning and the delay to more costly disease stages and settings. The magnitude of this cost offset and of the effect of donepezil on health-related quality of life depends on the model’s assumptions about the duration of the drug effect, where controlled data are lacking. If the drug effect exceeds 2 years, the model predicts that for mild AD the drug would pay for itself in terms of cost offsets.
CONCLUSIONS: The results of the cost-effectiveness model presented here suggest that donepezil may be cost-effective but additional controlled data on long-term drug efficacy are needed.
This article has been cited by other articles:
|
|
 |
|
  S. Petrou and E. Kupek Estimating Preference-Based Health Utilities Index Mark 3 Utility Scores for Childhood Conditions in England and Scotland Med Decis Making, May 1, 2009; 29(3): 291 - 303. [Abstract] [PDF]
|
|
|
|
 |
|
 P. Raina, P. Santaguida, A. Ismaila, C. Patterson, D. Cowan, M. Levine, L. Booker, and M. Oremus Effectiveness of Cholinesterase Inhibitors and Memantine for Treating Dementia: Evidence Review for a Clinical Practice Guideline Ann Intern Med, March 4, 2008; 148(5): 379 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Claxton, J. T. Cohen, and P. J. Neumann When Is Evidence Sufficient? Health Aff., January 1, 2005; 24(1): 93 - 101. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Feldman, S. Gauthier, J. Hecker, B. Vellas, M. Hux, Y. Xu, E.M. Schwam, S. Shah, and V. Mastey Economic evaluation of donepezil in moderate to severe Alzheimer disease Neurology, August 24, 2004; 63(4): 644 - 650. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Cummings Use of Cholinesterase Inhibitors in Clinical Practice: Evidence-Based Recommendations Focus, April 1, 2004; 2(2): 239 - 252. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. McMahon, S. S. Araki, E. A. Sandberg, P. J. Neumann, and G. S. Gazelle Cost-Effectiveness of PET in the Diagnosis of Alzheimer Disease Radiology, August 1, 2003; 228(2): 515 - 522. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D.L. Murman, Q. Chen, M.C. Powell, S.B. Kuo, C.J. Bradley, and C.C. Colenda The incremental direct costs associated with behavioral symptoms in AD Neurology, December 10, 2002; 59(11): 1721 - 1729. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. KAVANAGH and M. KNAPP Costs and cognitive disability: modelling the underlying associations The British Journal of Psychiatry, February 1, 2002; 180(2): 120 - 125. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. L. Murman The Costs of Caring: Medical Costs of Alzheimer's Disease and The Managed Care Environment J Geriatr Psychiatry Neurol, December 1, 2001; 14(4): 168 - 178. [Abstract] [PDF]
|
|
|
|
|
|
P. J. Neumann, S. S. Araki, A. Arcelus, A. Longo, G. Papadopoulos, K. S. Kosik, K. M. Kuntz, and A. Bhattacharjya Measuring Alzheimer's disease progression with transition probabilities: Estimates from CERAD Neurology, September 25, 2001; 57(6): 957 - 964. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Caro, D. Getsios, K. Migliaccio-Walle, G. Raggio, and A. Ward Assessment of health economics in Alzheimer's disease (AHEAD) based on need for full-time care Neurology, September 25, 2001; 57(6): 964 - 971. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G B FRISONI Structural imaging in the clinical diagnosis of Alzheimer's disease: problems and tools J. Neurol. Neurosurg. Psychiatry, June 1, 2001; 70(6): 711 - 718. [Full Text] [PDF]
|
|
|
|
|
|
P. J. Neumann, E. A. Sandberg, S. S. Araki, K. M. Kuntz, D. Feeny, and M. C. Weinstein A Comparison of HU12 and HU13 Utility Scores in Alzheimer's Disease Med Decis Making, October 1, 2000; 20(4): 413 - 422. [Abstract] [PDF]
|
|
|
|
|
|
P. M. McMahon, S. S. Araki, P. J. Neumann, G. J. Harris, and G. S. Gazelle Cost-effectiveness of Functional Imaging Tests in the Diagnosis of Alzheimer Disease Radiology, October 1, 2000; 217(1): 58 - 68. [Abstract] [Full Text]
|
|
|
|
|
|
A. I. Mushlin Disease, drugs, decisions, and dollars Neurology, April 1, 1999; 52(6): 1115 - 1115. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
