Psychische Erkrankungen in der Lebensspanne ... - DGPPN

Topic 15 G Pharmakotherapie // Pharmacotherapy
44 % of the patients received no pharmacotherapy, 50 % were treated
with oral ChEI (donepezil, galantamine, rivastigmine caps.,),
6 % received memantine, and 7 % other medication (includ ing patients
on double therapy). In 619 patients transdermal treatment
with rivastigmine was initiated. Insufficient efficacy, side effects,
and lack of compliance were the prevalent reasons for a switch to
TT. Patients with TT were monitored for 2 months (mean). Results
on compliance, handling, patient satisfaction and caregiver satisfaction
with the medication are presented in Figure 1. Physi cians
rated the efficacy of the TT as good or excellent in 80 %, and maintained
TT in 88 % of the patients. The most frequent side- effects
with TT were: nausea (2 %), vomiting (0.5 %) and diarrhoea (0.8 %).
Local skin reactions (mostly erythema) were reported in 4.7 % of
the patients, while 3.7 % of the patients discontinued TT due to skin
reactions. Conclusion: In comparison to oral AD therapy, transdermal
treatment with rivastigmine substantially improved compliance,
patient and caregiver satisfaction and showed an excellent
tolerability profile.
015
Introducing a methodology to use ADL outcomes in the assessment
of the cost-effectiveness of AD treatments: a case study
using rivastigmine patch
Balazs Nagy (University of Sheffield, UK)
A. Brennan, A. Brandtmüller, S. K. Thomas, M. Gallagher, S. D. Sullivan
Introduction: Measures of activities of daily living (ADL), as a
functional assessment, may be a more accurate payer-relevant reflection
of disease burden than cognitive assessments in Alzheimer’s
disease. The objective of this study is to evaluate the usefulness of
ADL instruments in cost-effectiveness modelling in Alzheimer’s
disease.
Method: A core economic model used MMSE scores from the IDE-
AL trial, which demonstrated significant benefits for rivastigmine
patch over placebo. The model was adapted to include ADCS-ADL
scores, with assumptions made on disease progression over a 5-year
period. The clinical pathway was populated based on the results of
the pivotal IDEAL trial, with 12-month follow-up data from patients
who received rivastigmine patch (n = 383) and 6-month
follow-up data from patients who received placebo (n = 282). The
progression of the disease was modelled beyond the study period of
one year by defining ADCS-ADL as a function of MMSE, and using
published equations on disease progression to predict the natural
decline of MMSE. The ADCS-ADL data were then mapped to the
Townsend-ADL scale for the prediction of institutionalization.
Costing variables included drugs, clinical monitoring, institutionalization
and community burden of care.
Discussion / Results: The model based on MMSE scores showed an
incremental cost per QALY gained over best supportive care of
£13,042, whereas the Townsend-ADL model indi cated total cost
savings, primarily attributable to number of institutionalized days
avoided over 5 years (67.5 days for ADL compared to 19.2 days for
MMSE). Results were insensitive to the type of regression analyses
(linear versus logistic) that were carried out to establish the relationship
of MMSE and ADL scales. Conclusions: Both the MMSE
and Townsend-ADL models demonstrated the cost-effectiveness of
rivastigmine patch for patients with AD. ADL modeling should be
regarded as a valuable technique for future economic evaluations in
the treatment of AD.
376
016
The cost-utility of the rivastigmine transdermal patch in the
man agement of patients with moderate Alzheimer‘s disease in
the US
Balazs Nagy (University of Sheffield, UK)
A. Brennan, A. Brandtmuller, S. K. Thomas, R. Akehurst
Introduction: A novel rivastigmine transdermal patch has recently
been approved in the US for the treatment of Alzheimer‘s disease
(AD) and Parkinson‘s disease dementia (PDD). The current objective
was to model the incremental cost-utility of the rivastigmine
patch versus best supportive care (BSC; no active treatment) in the
management of AD, from the perspective of a US payer.
Method: The incremental costs and number of institutional days
avoided with the rivastigmine patch versus BSC over 5 years were
calculated using an economic model. Changes in Mini Mental State
Examination (MMSE) scores over a 5-year period were used as a
measure of the progression of AD. The clinical pathway was populated
based on the results of a large clinical trial, with 12-month
follow-up data from patients who received the rivastigmine patch
(n = 383) and 6-month follow-up data from patients who received
placebo (n = 282). Progression of the disease was modeled beyond
the study period using published equations to predict the natural
decline of MMSE in AD patients. Costing variables included drugs
and community care and institutionalization. The rivastigmine
patch was shown to actually save $1,986 per patient and help avoid
64.3 institutional days over 5 years, proving it to be a dominant
strategy over BSC. One-way sensitivity analysis suggested that the
main determinants of cost-effectiveness were: the likelihood of institutionalization;
the relationship between MMSE states and quality
of life; and the analytic perspective adopted.
Discussion / Results: In this model, the rivastigmine patch has a
more favorable cost-effectiveness profile compared with many
treatments currently reimbursed by US health care agencies.
Further research studies focusing on effects on activities of daily
living to demonstrate cost effectiveness and benefits of treatment
are warranted.
Freitag, 27. 11. 2009, 13.30 – 15.00 Uhr, Halle 11.1
P-052 Posterpräsentation
Pharmakotherapie 1 (Antipsychotika)
Vorsitz: C. Hiemke (Mainz)
001
Messung der Serumspiegel von Risperidon und 9-Hyrdoxyrisperidon
in einem Kollektiv von Kindern und Jugendlichen
Hans-Willi Clement (Universitaetsklinikum Freiburg, Kinder- und
Jugendpsychiatrie)
C. Taram, P. Heiser, C. Fleischhaker, E. Schulz
Einleitung: Risperdal® ist zurzeit das einzige Medikament, das in
Deutschland zur Behandlung der Störung des Sozialverhaltens zugelassen
ist. Der Wirkstoff Risperidon wird über das Cytochrom-
P450-2D6-System in der Leber rasch metabolisiert. Zu einem geringen
Prozentsatz wird es auch über CYP-3A4 verstoffwechselt
Die Summe der Serumkonzentrationen von Risperidon und Hydroxy-Risperidon
zeigen eine signifikante Korrelation zu der verabreichten
24 Stunden Dosis. Die Plasmahalbwertszeit der gesamten
antipsychotischen Fraktion, das heißt von Risperidon und all
seinen aktiven Metaboliten, beträgt 24 Stunden.
Methode: 70 Proben von Kindern und Jugendlichen wurden auf
Risperidon und 9-OH-Risperidon untersucht. Die häufigste Diag-