Donepezil - Pharmacoeconomic implications of therapy

Donepezil is a specific acetylcholinesterase inhibitor that can improve sym ptoms in patients with mild-to-moderate Alzheimer's disease; cognitive func tion is maintained above baseline levels for up to 1 year and normal declin e of cognitive function is slowed. The ability of the patient to perform da ily activities and neuropsychiatric symptoms may also be improved by donepe zil, but data are limited. Donepezil is not expected to alter the underlying neurodegenerative process , and the response to the drug varies between individuals. In the absence of validated instruments to measure quality of life, it is n ot clear how donepezil affects this parameter. In a US survey of caregivers of patients with Alzheimer's disease who were being cared for at home at the start of the 6-month study period, treatment with donepezil did not increase overall direct medical costs. The acquisit ion cost of the drug was balanced by reduced institutionalisation costs. Economic analyses using Markov models from the US, UK and Canada suggest do nepezil initiated in the early stages of disease may be effectively cost ne utral as a result of patients remaining in a nonsevere state of disease for a longer time.