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Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for alzheimer’s disease

Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for alzheimer’s disease
Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for alzheimer’s disease
Objectives: Systematic review of the clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for people suffering from Alzheimer's disease.
Methods: Sixteen electronic databases (including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information. Randomized controlled trials (RCTs) and economic studies were selected. Clinical effectiveness was assessed on measurement scales assessing progression of Alzheimer's disease on the person's global health, cognition, functional ability, behavior and mood, and quality of life. Cost-effectiveness was presented as incremental cost per year spent in a nonsevere state (by Mini Mental Health State Examination) or quality-adjusted life-year.
Results: Twelve of 15 RCTs included were judged to be of good quality. Although donepezil had beneficial effects in Alzheimer's patients on global health and cognition, rivastigmine on global health, and galantamine on global health, cognition, and functional scales, these improvements were small and may not be clinically significant. Measures of quality of life and behavior and mood were rarely assessed. Adverse effects were usually mild and transient. Cost-effectiveness base case estimates ranged from £2,415 savings to £49,476 additional cost (1997 prices) per unit of effect for donepezil and a small savings for rivastigmine. Estimates were not considered robust or generalizable.
Conclusions: Donepezil, rivastigmine, and galantamine appear to have some clinical effect for people with Alzheimer's disease, although the extent to which these translate into real differences in everyday life remains unclear. Due to the nature of current economic studies, cost-effectiveness remains uncertain and the impact on different care sectors has been inadequately investigated. Further research is needed to establish the actual benefits of acetylcholinesterase inhibitors (AChEls) for people with Alzheimer's disease and their caregivers, the relationship of these changes to clinical management, and careful prospective evaluation of resource and budgetary consequences.
alzheimer's disease, cholinesterase inhibitors, review, donepezil, rivastigmine, galantamine, clinical and cost effectiveness
0266-4623
497-507
Clegg, A.
4a42c0bf-8146-4536-9aa9-a2710db902d7
Bryant, J.
508f497c-8b5a-468f-a37d-be9c26e4e49d
Nicholson, T.
3f7061b0-5d3b-4ed3-b2de-1a50f0d5983e
McIntrye, L.
770275b1-0313-446f-abed-d4f2646d3ab5
de Broe, S.
2a35c170-ee47-42cb-b47a-a46d19e5a695
Gerard, K.
ce7b5859-1c5f-4e9f-b5ba-acbd68d0f90e
Waugh, N.
4e268891-bf0b-4baa-9933-60257822286c
Clegg, A.
4a42c0bf-8146-4536-9aa9-a2710db902d7
Bryant, J.
508f497c-8b5a-468f-a37d-be9c26e4e49d
Nicholson, T.
3f7061b0-5d3b-4ed3-b2de-1a50f0d5983e
McIntrye, L.
770275b1-0313-446f-abed-d4f2646d3ab5
de Broe, S.
2a35c170-ee47-42cb-b47a-a46d19e5a695
Gerard, K.
ce7b5859-1c5f-4e9f-b5ba-acbd68d0f90e
Waugh, N.
4e268891-bf0b-4baa-9933-60257822286c

Clegg, A., Bryant, J., Nicholson, T., McIntrye, L., de Broe, S., Gerard, K. and Waugh, N. (2002) Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for alzheimer’s disease. International Journal of Technology Assessment in Health Care, 18 (3), 497-507. (doi:10.1017/S026646230200034X).

Record type: Article

Abstract

Objectives: Systematic review of the clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for people suffering from Alzheimer's disease.
Methods: Sixteen electronic databases (including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information. Randomized controlled trials (RCTs) and economic studies were selected. Clinical effectiveness was assessed on measurement scales assessing progression of Alzheimer's disease on the person's global health, cognition, functional ability, behavior and mood, and quality of life. Cost-effectiveness was presented as incremental cost per year spent in a nonsevere state (by Mini Mental Health State Examination) or quality-adjusted life-year.
Results: Twelve of 15 RCTs included were judged to be of good quality. Although donepezil had beneficial effects in Alzheimer's patients on global health and cognition, rivastigmine on global health, and galantamine on global health, cognition, and functional scales, these improvements were small and may not be clinically significant. Measures of quality of life and behavior and mood were rarely assessed. Adverse effects were usually mild and transient. Cost-effectiveness base case estimates ranged from £2,415 savings to £49,476 additional cost (1997 prices) per unit of effect for donepezil and a small savings for rivastigmine. Estimates were not considered robust or generalizable.
Conclusions: Donepezil, rivastigmine, and galantamine appear to have some clinical effect for people with Alzheimer's disease, although the extent to which these translate into real differences in everyday life remains unclear. Due to the nature of current economic studies, cost-effectiveness remains uncertain and the impact on different care sectors has been inadequately investigated. Further research is needed to establish the actual benefits of acetylcholinesterase inhibitors (AChEls) for people with Alzheimer's disease and their caregivers, the relationship of these changes to clinical management, and careful prospective evaluation of resource and budgetary consequences.

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More information

Published date: 2002
Keywords: alzheimer's disease, cholinesterase inhibitors, review, donepezil, rivastigmine, galantamine, clinical and cost effectiveness

Identifiers

Local EPrints ID: 19261
URI: http://eprints.soton.ac.uk/id/eprint/19261
ISSN: 0266-4623
PURE UUID: f921cc5d-1f9f-4c5f-b586-19684f406aec

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Date deposited: 31 Jan 2006
Last modified: 15 Jul 2019 19:27

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