Donepezil, rivastigmine, galantamine and memantine for ...

TABLE 52 Characteristics of economic evaluation studies for galantamine
Disease (AHEAD) model developed by Caro and
colleagues. 131 In line with the AHEAD model, all
studies report analyses based on a short-term
module covering an initial 6-month (trial) period,
followed by a long-term module over a 10-year
time horizon.
Assessment of Health Economics in Alzheimer’s
Disease (AHEAD) model
The AHEAD model rests on the concept of need
for FTC, and simulates the experience of a cohort
of patients across three possible health states: pre-
FTC, FTC and death. The model uses patient
characteristics at a given time to estimate the
likelihood of disease progression over time to a
level at which FTC is required. When in the pre-
FTC health state, patients are assumed to live at
home or in a residence that does not provide
extensive care. When in FTC, patients have a
requirement for a significant amount (for the
greater part of the day) of paid care and
supervision each day, regardless of the location of
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Health Technology Assessment 2006; Vol. 10: No. 1
Characteristic Getsios et al. 95 Garfield et al. 96 Caro et al. 97 Migliaccio-Walle Ward et al. 99
et al. 98
Publication year 2001 2002 2002 2003 2003
Country setting Canada Sweden The Netherlands USA UK
Base year prices 1999 (Can$) 1998 (€/SEK) 1998 (NLG) 2000 (US$) 2001 (UK£)
Intervention Galantamine Galantamine Galantamine Galantamine 16 Galantamine 16
24 mg daily 12 mg three times (dose not stated and 24 mg daily and 24 mg daily
daily (36 mg) in text) a
Study type CEA model (CUA) CEA model CEA model (CUA) CEA model CEA model (CUA)
Study group – AD Mild to moderate Mild to moderate Mild to moderate Mild to moderate Mild to moderate
(subgroup of (subgroup of (subgroup of
moderate AD) moderate AD) moderate AD)
Perspective Not stated Not stated Perspective stated Stated – third-party Stated – UK NHS
(appears to be (appears to be to be broader than payer and PSS
third-party payer) third-party payer) that of the Dutch
healthcare system b
Industry role Not stated – Research Research supported Co-author/funding Funding from
modelling supported by by Janssen from Janssen Johnson and
methods funded Janssen Research Research Pharma Johnson
by Janssen Pharma Foundation Foundation Pharmaceutical
Research (Janssen)
Study base-case Reduced time in Reduced time in Reduced time in Reduced time in Reduced time in
‘headline’ need of FTC, need of FTC and need of FTC, QALY need of FTC and need of FTC,
predictions/findings QALY gains and cost savings over gains and cost cost savings over QALY gains,
cost savings over time savings over time time almost cost neutral
time position at
10 years
a 61 Caro and colleagues refer to two clinical trials for resource use data: Raskind and colleagues (2000) and Wilcock and
colleagues (2000). 64
b To include all direct formal costs, regardless of reimbursement by the healthcare authorities.
care (institution or community setting), or who
provides the care; incorporating paid care received
at home or elsewhere in the community in
addition to care in an institutional setting.
Regardless of disease progression to FTC, patients
are subject to the simultaneous risk of death.
The AHEAD model determines the proportion of
the patient cohort in each state over time using
predictive risk/hazard equations. The predictive
risk equations are based on longitudinal
epidemiological data reported by Stern and
colleagues, 132 and derive the time-dependent
hazards of requiring FTC, and of death, according
to patient characteristics present at a given time.
Stern and colleagues 132 report a prospective
cohort study of 236 patients, followed up semiannually
for up to 7 years. All patients met
NINCDS-ADRDA criteria for probable AD and
had mild dementia at the initial visit. The study
constructed prediction algorithms for two
97