Donepezil, rivastigmine, galantamine and memantine for ...

Launois and colleagues report that over 5 years
the time spent in autonomy for patients treated
with memantine was 12% greater than for patients
treated with donepezil and 24% longer for
patients on no pharmacotherapy. Time to
institutionalisation was 7 and 11% longer,
respectively.
Estimation of costs
Jones and colleagues 104 estimated health state
costs by dependency and setting: communitydependent
patients £5670, community
independent at £2234, institution dependent at
£32,919 and institution independent at £21,102
per 6 months. Data for these cost estimates are not
presented in any detail, with the authors citing the
LASER-AD Study 146 as the source for resource use
calculations. These costs are much higher than
other published cost data for AD, especially for
severe AD [see the section ‘Costing considerations
in the treatment of AD’ (p. 108)].
Jones and colleagues report that over 2 years
memantine is expected to result in a cost
reduction of £1963 (SD £4504). Subgroup analysis
was undertaken where treatment groups at the
start of the model were assumed to be only those
classed as (a) moderately severe and independent,
(b) moderately severe and dependent, (c) severe
and independent and (d) severe and dependent.
For each category of AD patient memantine was a
cost-saving strategy, except for the group of severe
and dependent patients where there was an
estimated additional cost of £42.
François and colleagues 103 consider costs for each
level of severity and setting from a societal
perspective, including community care, hospital
services, informal care and institutional costs. Data
were analysed, using a US resource utilisation
study, to estimate cost per level of severity, setting
and level of dependency (costs for mild to
moderate were assumed to be the same as those
Health Technology Assessment 2006; Vol. 10: No. 1
for moderately severe patients). Costs reflected
2001 prices and estimates used are presented in
Table 54. The cost for memantine (20 mg) in
Finland was €3.98 per day (excluding VAT). Costs
were discounted at 5% per annum. François and
colleagues report that over 5 years memantine
treatment was cost saving compared with no
pharmacological treatment, with mean savings of
€1687 per patient; however, these estimates are
from a societal perspective (see Appendix 14 for
sensitivity analysis).
Launois and colleagues report that over 5 years
patients treated with memantine showed a cost
saving of €5979 and €12,364 in total healthcare
costs (societal perspective) compared with
donepezil and no treatment, respectively.
Cost-effectiveness of memantine
Appendix 14 presents summary findings on the
cost-effectiveness of memantine, with François and
colleagues 103 and Jones and colleagues 104
reporting a picture of cost savings over time
(2 years) with patient benefits in terms of
improvements in time spent in an independent
state, time in the community and QALYs. The
findings from the UK cost-effectiveness study
presented by Jones and colleagues are summarised
below.
Jones and colleagues 104 report base-case analysis
over 2 years that shows memantine as a dominant
strategy (compared with no pharmacological
treatment); treatment with memantine was
associated with an improvement of 0.10 year (SD
0.04) in time spent in an independent state,
a delay of 0.06 year (3 weeks) (SD 0.04) before
institutionalisation, an increase of 0.04 QALY (SD
0.03) and a cost reduction of £1963 over 2 years
(SD £4504).
Subgroup analyses were undertaken for four groups
of patients: (a) initially moderately severe and
TABLE 54 Summary of cost estimates used by François and colleagues 103 in analysis of cost-effectiveness of memantine (€, 2001)
Severity Community Institution
Mild–moderate 4,844 17,350
Moderately severe 5,865 17,350
Severe 10,380 19,291
Independent Dependent Independent Dependent
Mild–moderate 4,224 6,457 14,574 24,114
Moderately severe 5,102 7,800 14,574 24,114
Severe 6,124 14,379 19,098 19,291
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