Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease

Objective: To demonstrate the use of cost-effectiveness analysis to assess the economic impact of donepezil in the treatment of mild or moderate AD. B ackground: Cost-effectiveness analyses show the relationship between resour ces used (costs) and health benefits achieved (effects) for an intervention compared with an alternative strategy. Methods: We developed a model to es timate the incremental cost-effectiveness of donepezil compared with no tre atment. Ne determined costs per quality-adjusted life-years gained, a measu rement that enhances the comparability of diverse studies. The model projec ts the progression of AD patients into more severe disease stages and into nursing homes, Data from a randomized clinical trial of donepezil were used to assess the drug's impact on the B-week probabilities of progression. Da ta on the costs and health-related quality of life associated with differen t disease stages and settings were taken from published estimates and our c ompanion cross-sectional study, respectively. Results: Donepezil costs are partially offset by a reduction in the costs of care due to enhancement in cognitive functioning and the delay to more costly disease stages and setti ngs. The magnitude of this cost offset and of the effect of donepezil on he alth-related quality of life depends on the model's assumptions about the d uration of the drug effect, where controlled data are lacking. If the drug effect exceeds 2 Sears, the model predicts that for mild AD the drug would pay for itself in terms of cost offsets. Conclusions: The results of the co st-effectiveness model presented here suggest that donepezil may be cost-ef fective but additional controlled data on long-term drug efficacy are neede d.