Background: Like other developed countries with aging populations, Sweden is expecting large increases in the prevalence of Alzheimer’s disease and corresponding escalations in the cost of care for patients with this disease. Galantamine, a new acetylcholinesterase inhibitor and nicotinic modulator, has proved effective in managing patients with Alzheimer’s disease in clinical trials.
Objective: To estimate the long-term health and economic impact of galantamine from the perspective of the public health payer in Sweden.
Design and setting: The Assessment of Health Economics in Alzheimer’s Disease (AHEAD) model compares galantamine treatment with no pharmacologic treatment. It consists of a module based on trial data followed by a projection module that uses the trial results to predict the time until patients require full-time care (FTC) or until their death. Forecasts were made for up to 10 years. The model was customised to Sweden by using Swedish resource use profiles obtained from the literature.
Results: Galantamine is predicted to reduce the time patients require FTC by almost 10%. Approximately 5.6 patients with mild-to-moderate disease would need to be treated to avoid one year of FTC. This would result in savings averaging 27 436 Swedish kronas (SEK) [3131 euros (EUR)] per patient over 10 years (1998 values). To avoid one year of FTC, 3.9 patients with moderate disease would need to be treated, with savings averaging SEK49 019 (EUR5594) per patient over 10.5 years. Sensitivity analyses of key parameters, such as proportion of patients needing FTC treated in the community, cost of care in an institution, cost of FTC care in the community, the price of galantamine, and the discount rate, found savings with galantamine would occur under most circumstances.
Conclusion: Galantamine can increase the time before patients require FTC, and may also lead to savings as treatment costs are offset by reductions in other healthcare expenditures and the costs associated with FTC.
Nursing Home Rivastigmine Tacrine Galantamine Nursing Home Care
This is a preview of subscription content, log in to check access
This research was supported in part by an unrestricted grant from Janssen Research Foundation. Anders Wimo and Bengt Winblad have been acting as consultants to most pharmaceutical companies who have developed antidementia drugs (e.g. Parke-Davis, Pfizer, Novartis, Janssen-Cilag, HMR/Aventis, Merz). They have no employment, stocks or research grants from these companies.
Roses AD. Alzheimer’s disease and the dementias. Sci Am 1997; 3: 1–11Google Scholar
Wimo A, Karlsson G, Sandman PO, et al. Cost of illness due to dementia in Sweden. Int J Geriatr Psychiatry 1997; 12: 857–61PubMedCrossRefGoogle Scholar
Small GW, Rabins PV, Barry PP, et al. Diagnosis and treatment of Alzheimer’s disease and related disorders. JAMA 1997; 278: 1363–71PubMedCrossRefGoogle Scholar
Brookmeyer R, Gray S, Kawas C. Projections of Alzheimer’s disease in the United States and the public health impact of delaying disease onset. AmJ Public Health 1998; 88: 1337–42CrossRefGoogle Scholar
Max W. The economic impact of Alzheimer’s disease. Neurology 1993; 43 Suppl. 4: S6–S10Google Scholar
Max W. Drug treatments for Alzheimer’s disease: shifting the burden of care. CNS Drugs 1999; 11: 363–72CrossRefGoogle Scholar
Goldin SM. Progress in the understanding and treatment of Alzheimer’s disease. Drug and Market Development 1998 Sep 1; 9 (9): 235–40Google Scholar
Wilcock GK, Lilienfeld S, Gaens E, et al. Efficacy and safety of galantamine in patients with mild tomoderate Alzheimer’s disease: a multicentre, randomized controlled trial. BMJ 2000; 321: 1445–9PubMedCrossRefGoogle Scholar
Tariot PN, Solomon PR, Morris MD, et al. A 5 month, randomised, placebo controlled trial of galantamine in Alzheimer’s Disease. Neurology 2000; 54: 2269–76PubMedCrossRefGoogle Scholar
Raskind MA, Peskind ER, Wessel T, et al. Galantamine in AD: A 6-month randomized, no treatment-controlled trial with a 6-month extension. The Galantamine USA-1 Study Group. Neurology 2000; 54: 2261–8PubMedCrossRefGoogle Scholar
Lubeck DP, Mazonson PD, Bowe T. Potential effect of tacrine on expenditures for Alzheimer’s disease. Pharmacoeconomics 1994; 6: 130–8Google Scholar
Henke CJ, Burchmore MJ. The economic impact of tacrine in the treatment of Alzheimer’s disease. Clin Ther 1997; 19: 330–45PubMedCrossRefGoogle Scholar
Wimo A, Karlsson G, Nordberg A, et al. Treatment of Alzheimer disease with tacrine: a cost-analysis model. Alzheimer Dis Assoc Dis 1997; 11: 191–200Google Scholar
Small GW, Donohue JA, Brooks RL. An economic evaluation of donepezil in the treatment of Alzheimer’s disease. Clin Ther 1998; 20: 838–50PubMedCrossRefGoogle Scholar
Neumann PJ, Hermann RC, Kuntz KM, et al. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease. Neurology 1999; 52: 1138–45PubMedCrossRefGoogle Scholar
Jonsson L, Lindgren P, Wimo A, et al. The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer’s disease: a Markov model. Clin Ther 1999; 21: 1230–40PubMedCrossRefGoogle Scholar
Fenn P, Gray A. Estimating long term cost savings from treatment of Alzheimer’s disease: a modeling approach. Pharmacoeconomics 1999; 16 (2): 165–74PubMedCrossRefGoogle Scholar
Hauber AB, Gnanasakthy A, Mauskopf JA. Savings in the cost of caring for patients with Alzheimer’s disease in Canada: an analysis of treatment with rivastigmine. Clin Ther 2000; 22: 439–51PubMedCrossRefGoogle Scholar
Caro JJ, Getsios D, Migliaccio-Walle K, et al. Assessment of health economics in Alzheimer’s disease (AHEAD) based on the need for full time care. Neurology 2001; 57: 964–71PubMedCrossRefGoogle Scholar
Stern Y, Tang MX, Albert M, et al. Predicting time to nursing home care and death in individuals with Alzheimer disease. JAMA 1997; 227: 806–12CrossRefGoogle Scholar
Stern Y, Sano M, Paulson J, et al. Modified mini-mental state examination: validity and reliability [abstract]. Neurology 1987; 37 Suppl. 1: 179Google Scholar
Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer’s disease. Am J Psychiatry 1984; 141: 1356–64PubMedGoogle Scholar
Doraiswamy PM, Bieber F, Kaiser L, et al. The Alzheimer’s disease assessment scale: patterns and predictors of baseline cognitive performance in multicenter Alzheimer’s disease trials. Neurology 1997; 48: 1511–7PubMedCrossRefGoogle Scholar
Annerstedt L. Group-living care: an alternative for the demented elderly. Dement Geriatr Cogn Disord 1997; 8: 136–42PubMedCrossRefGoogle Scholar
Lopez OL, Becker JT, Wisniewski S, et al. Cholinesterase inhibitor treatment alters the natural history of Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2002; 72: 310–4PubMedCrossRefGoogle Scholar
Agüero-Torres H, Fratiglioni L, Winblad B. Natural history of Alzheimer’s disease and other dementias: review of the literature in the light of the findings from the Kungsholmen project. Int J Geriatr Psychiatry 1998; 13: 755–66PubMedCrossRefGoogle Scholar
Annerstedt L, Sanada J, Gustafson L. Adynamic long-term care system for the demented elderly. Int Psychogeriatr 1996; 8: 561–74PubMedCrossRefGoogle Scholar
Jönsson L, Lindgren P, Wimo A, et al. Costs of mini mental state examination-related cognitive impairment. Pharmacoeconomics 1999; 16 (4): 409–16PubMedCrossRefGoogle Scholar
Wimo A, Mattson B, Krakau I, et al. Cost-utility analysis of group living in dementia care. Int J Technol Assess Health Care 1995; 11: 49–65PubMedCrossRefGoogle Scholar
Wimo A, Ljunggren G, Winblad B. Costs of dementia and dementia care: a review. Int J Geriatr Psychiatry 1997; 12: 841–56PubMedCrossRefGoogle Scholar
Svensson M, Edelbalk PG, Persson U. Group living for elderly patients with dementia: a cost analysis. Health Policy 1996; 38: 83–100PubMedCrossRefGoogle Scholar
Getsios D, Caro J, Caro G, et al. Assessment of health economics in Alzheimer’s disease (AHEAD), Galantamine treatment in Canada. Neurology 2001; 57: 972–8PubMedCrossRefGoogle Scholar
Caro JJ, Salas M, Ward A, et al. Economic analysis of galantamine, a cholinesterase inhibitor, in the treatment of patients with mild-to-moderate Alzheimer’s disease in The Netherlands. Dement Geriatr Cogn Disord. In pressGoogle Scholar