Economic Evaluations of Treatment Options in Patients with Alzheimer's Disease – A Systematic Review

Aim of the study: Alzheimer's disease (AD) is one of the most common diseases for the elderly with 60–80% of all dementia patients. By 2030 it is predicted that the number of people suffering from AD will increase to 65.7 million. With this increase, also the costs are going to rise. In 2010 the worldwide costs of dementia are estimated to US$604 billion. The objective of this study is to conduct a systematic review on pharmacoeconomic studies of drug treatment options in patients with AD. Methods: A systematic literature search was performed including a time frame from January 1st 2007 to July 15th 2010, based on a previous systematic review by Oremus (2008) until the year 2007. Results: Finally, 7 articles out of 2067 were included in this systematic review. Four different groups of medication have to be compared. The ICER in the group of patients treated with donepezil vs. no drug treatment ranges from -19,064.30 €/QALY to 281,416.13 €/QALY. Patients treated with donepezil vs. placebo show an ICER with a range of a dominant value (not specified) up to 20,866.77 €/QALY. Memantine in addition to the treatment with donepezil shows a Range of ICER from -26,094.60 €/QALY up to 6,818.33 €/QALY. The ICER of memantine monotherapy ranges between -66,978.94 €/QALY to 63,087.20 €/QALY. The economic evaluation of galantamine in comparison to usual care without any AD drugs shows an ICER in the range of 1,894.70 €/QALY to 6,953 €/QALY. Conclusion: The 7 identified publications underline that the treatment of CEIs or memantine in patients with AD is reasonable. Treatment with these drugs in most cases, depending on different assumptions and modulation of variables in sensitivity analysis, seems to be a cost effective strategy or even a cost saving strategy. The comparability of results regarding different economic evaluations is limited because of different assumptions methods used.