Donepezil, rivastigmine, galantamine and memantine for ...

124
Economic analysis
TABLE 70 Key inputs to SHTAC AD model
Model input/variable Input value Detail/comment Source
Cohort characteristics
Age (years): mean (SD)
AD duration (years): mean (SD)
ADAS-cog: mean (SD)
Presence of EPS (%)
Presence of psychotic symptoms (%)
74 (6)
1 (0.5)
24 (9)
6.2
10
Surveys reported by Kavanagh and Knapp 185,186
(Appendix 17, [commercial/academic
confidential information removed]) An estimate
of £11,247 per year for the mean expected cost
for those patients in FTC is used.
Presentation of results
Findings are reported on the mean incremental
gain in QALYs and mean incremental cost per
treated patient, based on a cohort analysis of 1000
patients (trial) and a simulation of 1000 trials. The
incremental cost per QALY is estimated. Findings
Normal distribution
Gamma distribution
Gamma distribution
Mean
Mean
Effectiveness of drug See Table 68 Gamma distribution (mean,
SE)
Clinical opinion a
Wilkinson et al.
AD2000 43
Stern et al.
AD2000 43
Drug cost See Table 56 By product/mean BNF (49)
Monitoring cost £108 (SD 25) per visit 2 outpatient visits
Gamma distribution
Cost for pre-FTC £328 per month
(assume SD £164)
Cost for FTC £937.30 per month
(assume SD of £468)
£3,937 per year
Gamma distribution
£11,247 per year, where
70% of patients are
publicly funded, and 52%
of FTC is community FTC d
Gamma distribution
132 c
183 b
SHTAC clinical review,
see Chapter 4
Stewart, 121
Kavanagh et al. 120
SHTAC estimate (see
above)
Mortality rate 11.2% per year Mean Martin et al. 129
Health state utilities
Pre-FTC: mean (SD)
FTC: mean (SD)
Discount rates
Future costs
Future benefits
0.60 (0.12)
0.34 (0.068)
1.5% per year
6.0% per year
Gamma distribution
Gamma distribution
Fixed rate
Fixed rate
NHS Reference Costs 151
Neumann et al. 166b
By UK convention,
NICE guidance
Costs are in 2002–03 £s.
a Data from Memory Assessment Research Centre, Moorgreen Hospital, Southampton, Hampshire (supported by a wide
range of clinical trial data, see Chapter 4).
b Assumption on SD by SHTAC.
c Data from Memory Assessment Research Centre, Moorgreen Hospital, Southampton, Hampshire, indicate that this is likely
to be less than 10% in a UK treatment group.
d Where all patients publicly funded and all institutionalised, estimate of mean cost per month is ~£1970 per month.
are presented using the cost-effectiveness plane,
showing incremental costs and QALYs. Using the
mean incremental benefits and cost per trial, the
‘net benefit’ associated with treatment is estimated,
and a CEAC is plotted, showing the probability of
a positive net benefit based on a range of
threshold values for the willingness to pay per
QALY.
Findings are also presented on the mean
difference in time spent in FTC over the 5 years
and figures are presented to show the expected