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KCE Reports 111 Interventions in Alzheimer’s Disease 63
prescriptions handled by the hospital pharmacy, as well as all other health expenditures
covered by the compulsory health insurance.
Most prescriptions for patients in elderly homes (also referred to as ROB/RVT or
MR/MRS) are included into Pharmanet, a small part (5% to 12%, depending on the
source) of the elderly homes however obtain their medication through a linked hospital
pharmacy and are thus included in Health. The codes defining the medication prescribed
differ between Pharmanet (APB-CNK code) and Health (RIZIV/INAMI code).
6.2.2 Selection of study population and variables for analysis
We first selected patients included in the PS/EP who had at least one reimbursed
prescription for a ChEI or Ebixa/memantine in the 2002-2006 period.
The demographic data analysed for these patients are
• year of birth,
• gender,
• year and month of death (if this occurred in the 2002-2006 period)
• residence type (home, ROB/RVT-MR/MRS).
As stays in an elderly home (ROB/RVT-MR/MRS) are also in part paid by the health
insurance (invoiced after each three months period, unless a change of service occurs
earlier), it is possible to define the type of residence over time.
We studied individual dates of prescriptions of specific medication for AD (ChEIs and
Ebixa), as well as concomitant prescriptions of antipsychotics and antidepressants.
Benzodiazepine prescriptions could not be evaluated as these drugs are not reimbursed
by the RIZIV/INAMI.
ChEI reimbursement started mid 2002. Ebixa reimbursement started in 2004. A few
earlier prescriptions were identified in the database and included.
After the data analyses had been completed and were being validated by a second
analyst, it was seen that a small number of prescriptions with the Pharmanet code were
unexpectedly present in the dataset Health. It was decided not to repeat the analyses as
it concerned a relatively small number of prescriptions and because of the high
proportion (a third) of ChEI treatment gaps of over 200 days among the additional
patients. The reason for this difference of coding was not clear at the time of writing of
the report.
6.2.3 Statistical analyses
The following analyses are performed:
1. Incident cases of patients on ChEl per year from 2002-2006 (number of new
patients), and prevalent cases in 2006 (number of patients who received prescriptions in
2006). An extrapolation of the yearly percentage increase of consumption was also
performed based on data for 2007, but this was based on data from Pharmanet only.
2. The extrapolation of these results from the PS/EP to the whole population of Belgium
is given by:
N patients (≤ 65 years) X 40 + N patients (> 65 years) X 20
3. The setting of the first ChEl prescription: home, hospital or ROB/RVT-MR/MRS.
Prescriptions handled by a hospital pharmacy are identified using the RIZIV/INAMI
medication codes. Patients in ROB/RVT-MR/MRS are identified using the lump sum paid
by the health insurance at three month intervals.
4. The routine use of new diagnostic markers. Recently a revision of the diagnostic
criteria for clinical diagnosis has been proposed, 20 reflecting the increasing importance of
new markers. We quantified the introduction of these new tests in routine practice in
Belgium, using the specific codes of reimbursement as a proxy for the test. The
following supportive features were studied (using reimbursement codes):