Introduction: Although numerous studies have evaluated predictors of nursing home placement (NHP), few have focused on the effects of cholinesterase inhibitor (ChEI) use on NHP. The objective of this study was to compare the risk of NHP between rivastigmine patients versus no-ChEI patients (control group), and secondly, between rivastigmine versus donepezil patients.
Methods: A retrospective analysis of a large US medical claims database was performed. Eligible subjects were identified from those who had continuous medical coverage from 1 April 2000 to 30 June 2002. Rivastigmine and donepezil subjects were new users, defined as having received no ChEI treatment during the initial 6 months of the study. Control subjects were diagnosed with Alzheimer’s disease (AD) at some point after the initial 6-month period. All subjects were followed from baseline (initiation of ChEI therapy or initial AD diagnosis) to the date of NHP or 30 June 2002, whichever occurred first.
Results: In the rivastigmine (n = 1181), donepezil (n = 3864), and control (n = 517) groups, 3.7%, 4.4% and 11.0% of subjects, respectively, had an NHP (p < 0.001 for rivastigmine versus control). A Cox proportional hazard model, controlling for age, gender, comorbidities and behavioural disorders, showed that the control subjects were almost 3-fold more likely to have NHP than rivastigmine subjects (hazard ratio [HR] = 2.71; 95% CI 1.82, 4.03). The difference in the risk of NHP was not significant between the rivastigmine and donepezil groups (HR = 1.23; 95% CI 0.89, 1.71).
Discussion: This study demonstrated that rivastigmine decreased the risk of NHP in a large insured population.
Nursing Home Behavioural Disorder Rivastigmine Tacrine Galantamine
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Research supported by Novartis Pharmaceuticals Inc., East Hanover (NJ), USA.
Inglis F. The tolerability and safety of cholinesterase inhibitors in the treatment of dementia. Int J Clin Pract Suppl 2002; 127: 45–63PubMedGoogle Scholar
Lamb HM, Goa KL. Rivastigmine: a pharmacoeconomic review of its use in Alzheimer’s disease. Pharmacoeconomics 2001; 19(3): 303–18PubMedCrossRefGoogle Scholar
Gaugier JE, Edwards AB, Femia EE, et al. Predictors of institutionalization of cognitively impaired elders: family help and the timing of placement. J Gerontol B Psychol Sci Soc Sci 2000; 55B (4): 247–55CrossRefGoogle Scholar
Gaugier KE, Kane RL, Kane RA, et al. Caregiving and institutionalization of cognitively impaired older people: utilizing dynamic predictors of change. Gerontologist 2003; 43(2): 219–29CrossRefGoogle Scholar
Hauber AB, Gnanasakthy A, Snyder EH, et al. Potential savings in the cost of caring for Alzheimer’s disease: treatment with rivastigmine. Pharmacoeconomics 2000; 17(4): 351–60PubMedCrossRefGoogle Scholar
Scarpini E, Scheltens P, Feldman H. Treatment of Alzheimer’s disease: current status and new perspectives. Lancet Neurol 2003; 2(9): 539–47PubMedCrossRefGoogle Scholar
Doody RS. Current treatments for Alzheimer’s disease: cholinesterase inhibitors. J Clin Psychiatry 2003; 64Suppl. 9: 11–7PubMedGoogle Scholar
Jann MW, Shirley KL, Small GW. Clinical pharmacokinetics and pharmacodynamics of cholinesterase inhibitors. Clin Pharmacokinet 2002; 41(10): 719–39PubMedCrossRefGoogle Scholar
AD Collaborative Group. Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomized double-blind trial. Lancet 2004; 363: 2105–15CrossRefGoogle Scholar
Lopez OL, Becker JT, Wisniewski SR, et al. Cholinesterase inhibitor treatment alters the natural history of Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2000; 72: 310–4CrossRefGoogle Scholar
Knopman D, Schneider L, Dais K, et al. Long-term tacrine (Cognex) treatment: effects on nursing home placement and mortality. Neurology 1996; 47(1): 166–77PubMedCrossRefGoogle Scholar
Weiner M, Neil R, Weiler WE, et al. Alzheimer’s disease under managed care: implications from Medicare utilization and expenditure patterns. J Am Geriatr Soc 1998; 46(6): 762–70PubMedGoogle Scholar
Eaker ED, Vierkant RA, Mickel SF. Predictors of nursing home admission and/or death in incident Alzheimer’s disease and other dementia cases compared to controls: a population-based study. J Clin Epidemiol 2002; 55(5): 462–8PubMedCrossRefGoogle Scholar
O’Donnell BF, Drachman DA, Barnes HJ, et al. Incontinence and troublesome behaviors predict institutionalization in dementia. J Geriatr Psychiatry Neurol 1992; 5(1): 45–52PubMedGoogle Scholar
Lopez OL, Wisniewski SR, Becker JT, et al. Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer disease. Arch Neurol 1999; 56(10): 1266–72PubMedCrossRefGoogle Scholar
Heyman A, Peterson B, Fillenbaum G, et al. Predictors of time to institutionalization of patients with Alzheimer’s disease: the CERAD experience, part XVII. Neurology 1997 May; 48(5): 1304–9PubMedCrossRefGoogle Scholar