PHARMACOTHERAPY FOR PEOPLE WITH ALZHEIMERS-DISEASE - A MARKOV-CYCLE EVALUATION OF 5 YEARS THERAPY USING DONEPEZIL

This article combines data from a clinical trial of donepezil with cos ting figures to evaluate expected direct costs of care over 5 years af ter diagnosis of Alzheimer's disease (AD) for patients aged 75 years a nd over at diagnosis. A Markov model simulates the progression of elde rly persons through changing levels of severity. The model compares th ree treatment regimes for each of two patient groups: mild AD at start of treatment; moderate AD at start of treatment. Patients are followe d until 5 years after the start of the treatment. Despite the acquisit ion costs, use of donepezil is approximately cost-neutral for both 5 m g and 10 mg treatment groups and for patients initially at either mild or moderate states of illness. Expected costs are slightly higher tha n for the placebo group, but higher expenditure on drugs is partly off set by lower costs of care consequent on treated patients not declinin g as rapidly as those untreated. The model showed that donepezil patie nts spent less time in the state of severe dementia, where costs of ca re are higher. Sensitivity analysis on key assumptions demonstrated th at expected costs were highly dependent on discount rate and, more sig nificantly, on the mortality rate. (C) 1998 John Wiley & Sons, Ltd.