Economic analysis of galantamine,a cholinesterase inhibitor,in the treatment of patients with mild to moderate Alzheimer's disease in the Netherlands

BACKGROUND: The economic impact of dementia on the Dutch health and social services is substantial. OBJECTIVE: To predict the long-term economic impact of galantamine, a cholinesterase inhibitor, in the treatment of Dutch patients with mild to moderate Alzheimer's disease. METHOD: A pharmacoeconomic model was used to predict long-term outcomes. It has two components: an initial module based on clinical trials of galantamine and a subsequent module that predicts when a patient will deteriorate to a level where full time care (FTC) is needed. The analyses take a broad perspective that includes all formal (paid) care, not just those covered by the Dutch health care system. Direct cost estimates were based on resource use profiles of patients with Alzheimer's disease in the Netherlands. Key inputs were tested in sensitivity analyses. RESULTS: After 10.5 years all patients are predicted to require FTC. For every hundred patients starting treatment on galantamine at the mild to moderate stage, it is predicted that 18 person-years of FTC will be avoided (14.4 discounted) and about 5 quality-adjusted years of life will be gained (3.9 discounted). Net savings for those starting treatment with galantamine are estimated at NLG 3,050 (1,676 UDS). The cost of galantamine accounts for only about 5.0% of the total cost of care for treated Alzheimer's patients. The direction of these results remained unchanged when input values and assumptions were tested in sensitivity analyses. CONCLUSIONS: The cholinesterase inhibitor galantamine is expected to bring savings in the direct cost of caring for patients with Alzheimer's disease in the Netherlands.