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KCE Reports 111 Interventions in Alzheimer’s Disease 53
Non-pharmacological treatments (n = 4)
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The literature search allowed the identification of two recent and comprehensive
reviews of economic evaluations of pharmaceutical 109 and non-pharmaceutical 1
interventions (Table 9). Therefore, of the 17 primary economic evaluations identified
since 2004 (Table 11), only those not already included in any of both reviews have been
summarised in in-house data extraction forms and in the discussion below. This
corresponds to 2 economic evaluations of non-pharmaceutical interventions published
after 2006 (the time limit of the NICE-SCIE review 1 ), 43, 104 and 2 economic evaluations of
pharmaceutical interventions (1 evaluations published after the end of 2007, the time
limit of the Oremus review, 109 and 1 older evaluation not yet included in this review). 72,
96
The extraction forms of those economic evaluations can be found in appendix.
5.2 OVERVIEW OF THE ECONOMIC EVALUATIONS
In this section we report the main findings of the selected reviews of economic
evaluations of pharmacological (research question 1) and non-pharmacological (research
question 2) treatments for Alzheimer disease. Whenever appropriate, the methodology
and the results of recent primary full economic evaluations are also described. A critical
assessment of the assumptions and the methodology used by those studies is provided
in the conclusions section.
5.2.1 Research question 1: Pharmacological interventions in AD patients
5.2.1.1 Summary of the systematic reviews
Donepezil, rivastigmine and galantamine in mild to moderately severe AD
Wimo 110 reviewed 11 model-based full economic evaluations of ChEI’s in the treatment
of AD. There were 5 studies on donepezil, 1 on rivastigmine and 5 on galantamine, all
published before 2004 (see Table 10 for the studies reviewed). According to Wimo, 110
ChEIs for mild-to-moderate AD have positive effects in terms of efficacy. Combined
with cost data, in most cases models indicate cost-effectiveness but variations in the
sensitivity analyses show that the assumed cost-effectiveness is not robust. Also, due to
methodological considerations, the validity of the models was difficult to judge. It was
further not possible to state that one ChEI is more cost-effective than another. Wimo 110
concludes that although models tend to indicate cost-effectiveness, there is a great need
for longer-term empirical data on resource use, costs and outcomes (including quality of
life data).
Loveman et al. 72 reviewed 9 full economic evaluations on the cost-effectiveness of
donepezil, 4 on rivastigmine and 5 on galantamine. All studies were published before
February 2004 and used placebo/usual care as comparator.
Regarding the cost-effectiveness of donepezil, studies have presented a variety of
conclusions. While donepezil treatment was mostly reported to be cost saving (often
based on the inclusion of informal care), other studies predicted additional incremental
costs associated with the treatment. However all studies presented donepezil as having
a beneficial effect on delay in disease progression (using MMSE cognitive function scores
to define the stages of disease severity),