Savings in the cost of caring for patients with Alzheimer's disease in Canada: An analysis of treatment with rivastigmine

Objective: To estimate per-patient potential cost savings using rivastigmin e in the treatment of Alzheimer's disease (AD) in Canada. Background: In recent years, new members of a class of pharmaceuticals know n as cholinesterase inhibitors have been introduced for the treatment of pa tients with AD. Two recent studies conducted in the United Kingdom acid the United States estimated potential cost savings from the new cholinesterase inhibitor rivastigmine. The present study combined the disease-progression model used in those 2 studies with Canadian costs to estimate per-patient potential savings resulting from the treatment of AD in Canada. Methods: Efficacy data from 2 pivotal, phase III clinical trials of rivasti gmine were used in a hazard model of disease progression to estimate Long-t erm differences in cognitive functioning between patients receiving rivasti gmine and patients receiving no treatment. We used the Mini-Mental State Ex amination (MMSE) score as our measure of disease progression. We also used Canadian costs of AD care, estimated as a function of MMSE score, to estima te cost savings experienced by treated patients compared with patients rece iving no treatment. All costs and cost savings are presented in 1997 Canadi an dollars. We used a societal perspective in this analysis. Results: Rivastigmine was estimated to delay the transition to more severe stages of AD by up to 188 days for patients with mild AD after 2 years of t reatment. For patients with mild-to-moderate and moderate disease, this del ay was estimated to be 106 and 44 days, respectively. For patients with the mild stage of AD, estimated average daily cost savings (excluding the cost of rivastigmine) ranged from Can $0.45 per patient per day at 6 months to Call $6.44 per patient per day after 2 years of treatment. For all patients , these estimated average daily cost savings ranged from a low of Can $0.71 per patient per day after 6 months of treatment to a high of Can $4.93 per patient per day after 2 years. Conclusion: On average, treatment with rivastigmine yields savings in the d irect cost of caring for AD patients that exceed the cost of the drug after 2 years of treatment.