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The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer's disease to nursing homes: cost-effectiveness analysis in France.

Touchon J, Lachaine J, Beauchemin C, Granghaud A, Rive B, Bineau S - Eur J Health Econ (2013)

Bottom Line: The combination of a cholinesterase inhibitor (ChEI) and memantine has been shown to significantly delay admission to nursing homes as compared to treatment with a ChEI alone.The objective of this cost-effectiveness analysis was to evaluate the economic impact of the concomitant use of memantine and ChEI compared to ChEI alone.In conclusion, combination therapy with memantine and a ChEI is a cost-saving alternative compared to ChEI alone as it is associated with lower cost and increased QALYs from both a societal and a healthcare perspective.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, University of Montpellier, Montpellier, France.

ABSTRACT
The costs associated with the care of Alzheimer's disease patients are very high, particularly those associated with nursing home placement. The combination of a cholinesterase inhibitor (ChEI) and memantine has been shown to significantly delay admission to nursing homes as compared to treatment with a ChEI alone. The objective of this cost-effectiveness analysis was to evaluate the economic impact of the concomitant use of memantine and ChEI compared to ChEI alone. Markov modelling was used in order to simulate transitions over time among three discrete health states (non-institutionalised, institutionalised and deceased). Transition probabilities were obtained from observational studies and French national statistics, utilities from a previous US survey and costs from French national statistics. The analysis was conducted from societal and healthcare system perspectives. Mean time to nursing home admission was 4.57 years for ChEIs alone and 5.54 years for combination therapy, corresponding to 0.98 additional years, corresponding to a gain in quality adjusted life years (QALYs) of 0.25. From a healthcare system perspective, overall costs were €98,609 for ChEIs alone and €90,268 for combination therapy, representing cost savings of €8,341. From a societal perspective, overall costs were €122,039 and €118,721, respectively, representing cost savings of €3,318. Deterministic and probabilistic (Monte Carlo simulations) sensitivity analyses indicated that combination therapy would be the dominant strategy in most scenarios. In conclusion, combination therapy with memantine and a ChEI is a cost-saving alternative compared to ChEI alone as it is associated with lower cost and increased QALYs from both a societal and a healthcare perspective.

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Related in: MedlinePlus

Deterministic sensitivity analysis (societal perspective). * All scenarios resulted in a positive incremental effectiveness gain for combination therapy
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Fig3: Deterministic sensitivity analysis (societal perspective). * All scenarios resulted in a positive incremental effectiveness gain for combination therapy

Mentions: From a societal perspective, combination therapy was dominant over ChEI alone in 15 out of 18 scenarios. For the other three scenarios, the combination therapy was deemed cost-effective compared to ChEI alone at the higher willingness-to-pay threshold of €34,598. Two of these scenarios (scenario 6: ICER 9,146 €/QALY; scenario 12: ICER 9,529 €/QALY) remained cost-effective at the lower willingness-to-pay threshold of €23,065, but the combination was no longer deemed cost-effective for scenario 14 (ICER: 33,082 €/QALY; Fig. 3).Fig. 3


The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer's disease to nursing homes: cost-effectiveness analysis in France.

Touchon J, Lachaine J, Beauchemin C, Granghaud A, Rive B, Bineau S - Eur J Health Econ (2013)

Deterministic sensitivity analysis (societal perspective). * All scenarios resulted in a positive incremental effectiveness gain for combination therapy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4201748&req=5

Fig3: Deterministic sensitivity analysis (societal perspective). * All scenarios resulted in a positive incremental effectiveness gain for combination therapy
Mentions: From a societal perspective, combination therapy was dominant over ChEI alone in 15 out of 18 scenarios. For the other three scenarios, the combination therapy was deemed cost-effective compared to ChEI alone at the higher willingness-to-pay threshold of €34,598. Two of these scenarios (scenario 6: ICER 9,146 €/QALY; scenario 12: ICER 9,529 €/QALY) remained cost-effective at the lower willingness-to-pay threshold of €23,065, but the combination was no longer deemed cost-effective for scenario 14 (ICER: 33,082 €/QALY; Fig. 3).Fig. 3

Bottom Line: The combination of a cholinesterase inhibitor (ChEI) and memantine has been shown to significantly delay admission to nursing homes as compared to treatment with a ChEI alone.The objective of this cost-effectiveness analysis was to evaluate the economic impact of the concomitant use of memantine and ChEI compared to ChEI alone.In conclusion, combination therapy with memantine and a ChEI is a cost-saving alternative compared to ChEI alone as it is associated with lower cost and increased QALYs from both a societal and a healthcare perspective.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, University of Montpellier, Montpellier, France.

ABSTRACT
The costs associated with the care of Alzheimer's disease patients are very high, particularly those associated with nursing home placement. The combination of a cholinesterase inhibitor (ChEI) and memantine has been shown to significantly delay admission to nursing homes as compared to treatment with a ChEI alone. The objective of this cost-effectiveness analysis was to evaluate the economic impact of the concomitant use of memantine and ChEI compared to ChEI alone. Markov modelling was used in order to simulate transitions over time among three discrete health states (non-institutionalised, institutionalised and deceased). Transition probabilities were obtained from observational studies and French national statistics, utilities from a previous US survey and costs from French national statistics. The analysis was conducted from societal and healthcare system perspectives. Mean time to nursing home admission was 4.57 years for ChEIs alone and 5.54 years for combination therapy, corresponding to 0.98 additional years, corresponding to a gain in quality adjusted life years (QALYs) of 0.25. From a healthcare system perspective, overall costs were €98,609 for ChEIs alone and €90,268 for combination therapy, representing cost savings of €8,341. From a societal perspective, overall costs were €122,039 and €118,721, respectively, representing cost savings of €3,318. Deterministic and probabilistic (Monte Carlo simulations) sensitivity analyses indicated that combination therapy would be the dominant strategy in most scenarios. In conclusion, combination therapy with memantine and a ChEI is a cost-saving alternative compared to ChEI alone as it is associated with lower cost and increased QALYs from both a societal and a healthcare perspective.

Show MeSH
Related in: MedlinePlus