Donepezil, rivastigmine, galantamine and memantine for ...

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Economic analysis
TABLE 73 Profile of mean estimated 5-year cost related to AD progression, by treatment option
Treatment Mean drug cost Mean increment Mean cost for Mean cost for FTC
(£) monitoring most (£) pre-FTC (£) (£)
Deterministic analysis
Usual care None None 8,408 14,180
Donepezil 10 mg 3,445 596 8,895 12,788
Rivastigmine 6–12 mg 2,450 597 8,907 12,756
Galantamine 24 mg 3,033 598 8,938 12,666
Mean difference; usual care
versus drug treatment
Probabilistic analysis
+2,976 +597 +505 –1,443
Usual care None None 8,738 13,175
Donepezil 10 mg 3,271 610 9,238 12,012
Rivastigmine 6–12 mg 2,518 611 9,247 12,048
Galantamine 24 mg 3,103 608 9,258 11,706
Mean difference; usual care
versus drug treatment
3,041 610 453 –1,277
incremental cost. The difference in time spent in
the health state FTC over the 5-year period ranges
from 1.42 months (donepezil) to 1.73 months
(galantamine 24 mg), across all analyses.
Deterministic results do not include a measure of
uncertainty for input parameters (e.g. costs,
utilities), and importantly do not include any
variation in the risk profile of the patient group
(assuming the typical patient has a risk profile
reflective of an ADAS-cog score at 24), therefore
the probabilistic results are likely to be the more
useful of the cost-effectiveness results presented
here.
Difference in incremental benefits (QALYs)
0.14
0.12
0.10
0.08
0.06
0.04
0.02
–0.02
–0.04
Table 73 presents the mean estimated 5-year costs
associated with the intervention and costs
associated with long-term care. The intervention
does offer a potential reduction in the costs
associated with FTC but these potential cost
savings do not compensate for the additional drug
and monitoring costs.
Figure 20 presents data from the SHTAC
probabilistic analysis (base case) on the
incremental costs and benefits across simulations,
using the cost-effectiveness plane (plotting
incremental cost and incremental benefits from
simulations). The figure shows the simulations for
0
–1500 –1000 –500 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500
Difference in incremental cost (£)
Donepezil 10 mg
Rivastigmine 6–12 mg
Galantamine 24 mg
FIGURE 20 Cost-effectiveness planes for donepezil, rivastigmine and galantamine, showing incremental costs and benefits from
SHTAC model analysis (base case)