Cost-effectiveness analysis of the treatment of mild and moderate Alzheimer’s disease in Brazil

Abstract

Objective:To perform a cost-effectiveness analysis of donepezil and rivastigmine therapy for mild and moderate Alzheimer’s disease (AD) from the perspective of the Brazilian Unified Health System.Method:A hypothetical cohort of 1,000 individuals of both sexes, aged >65 years, and diagnosed with AD was simulated using a Markov model. The time horizon was 10 years, with 1-year cycles. A deterministic and probabilistic sensitivity analysis was performed.Results:For mild AD, the study showed an increase in quality-adjusted life years (QALYs) of 0.61 QALY/21,907.38 Brazilian reais (BRL) for patients treated with donepezil and 0.58 QALY/BRL 24,683.33 for patients treated with rivastigmine. In the moderate AD group, QALY increases of 0.05/BRL 27,414.96 were observed for patients treated with donepezil and 0.06/BRL 34,222.96 for patients treated with rivastigmine.Conclusions:The findings of this study contradict the standard of care for mild and moderate AD in Brazil, which is based on rivastigmine. A pharmacological treatment option based on current Brazilian clinical practice guidelines for AD suggests that rivastigmine is less cost-effective (0.39 QALY/BRL 32,685.77) than donepezil. Probabilistic analysis indicates that donepezil is the most cost-effective treatment for mild and moderate AD.

Model-Based Economic Evaluations of Interventions for Dementia: An Updated Systematic Review and Quality Assessment

“…The 23 included studies covered a variety of populations and conditions related to dementia. Specifically, 10 (43%) studies focused on AD [ 30 – 39 ], five studies (22%) examined MCI and memory concerns [ 40 – 44 ], and three studies (13%) targeted people with other types of dementia [ 45 – 47 ] (Table 1 ). There were also individual studies that addressed certain dementia prevention or diagnostic strategies for specific populations, including couples with one heterozygous Huntington disease individual [ 48 ], people at risk of dementia without a specific health condition [ 49 ], those with idiopathic normal pressure hydrocephalus (iNPH) [ 50 ], or informal caregivers of people with dementia [ 51 ].…”

“…Eight studies (35%) were conducted in Europe [ 31 , 37 , 42 , 45 , 47 , 49 – 51 ], eight (35%) were conducted in the US [ 32 – 34 , 36 , 39 – 41 , 48 ], and two (9%) were conducted in Canada [ 44 , 46 ]. Additionally, single studies (4% each) were conducted in Australia [ 52 ], Brazil [ 30 ], South Korea [ 43 ], Taiwan [ 38 ], and Thailand [ 35 ].…”

“…Pharmacological interventions were the most evaluated type of intervention in the included studies ( n = 10, 43%) [ 30 – 37 , 41 , 45 ] in relation to memory loss and cognitive decline symptoms. Within this range, rivastigmine, galantamine, and donepezil were from the category of cholinesterase inhibitors primarily approved for the treatment of memory loss.…”

Alzheimer's disease: an epidemiological analysis over the number of hospitalizations and deaths in Brazil

“…For the Brazilian Unified Health System, data regarding drug treatment indicate that there was a 109% increase in expenses over a 5-year period, from R$75.6 million in 2007 to R$157.8 million in 2011. 26,27 Based on prior studies and the population aging, the number of deaths and hospitalizations due to AD in Brazil has increased. Thus, epidemiological knowledge about each of these factors is crucial.…”

“…For the Brazilian Unified Health System, data regarding drug treatment indicate that there was a 109% increase in expenses over a 5-year period, from R$75.6 million in 2007 to R$157.8 million in 2011. 26 27 …”