Clincal and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease

A. Clegg, J. Bryant, T. Nicholson, L. McIntyre, S. de Broe, K. Gerard, Norman Robert Waugh

Research output: Contribution to journalArticle

63 Citations (Scopus)

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(including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information.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 pound2,415 savings to pound49,476 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.

Original languageEnglish
Pages (from-to)497-507
Number of pages10
JournalInternational Journal of Technology Assessment in Health Care
Volume18
Issue number3
DOIs
Publication statusPublished - 2002

Keywords

  • Alzheimer's disease
  • cholinesterase inhibitors
  • review
  • PLACEBO-CONTROLLED TRIAL
  • RANDOMIZED CONTROLLED TRIAL
  • DOUBLE-BLIND
  • ECONOMIC-EVALUATION
  • GLOBAL FUNCTION
  • US MULTICENTER
  • DRUG-TREATMENT
  • HEALTH-CARE
  • EFFICACY
  • SAFETY

Cite this

Clincal and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease. / Clegg, A.; Bryant, J.; Nicholson, T.; McIntyre, L.; de Broe, S.; Gerard, K.; Waugh, Norman Robert.

In: International Journal of Technology Assessment in Health Care, Vol. 18, No. 3, 2002, p. 497-507.

Research output: Contribution to journalArticle

Clegg, A. ; Bryant, J. ; Nicholson, T. ; McIntyre, L. ; de Broe, S. ; Gerard, K. ; Waugh, Norman Robert. / Clincal and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease. In: International Journal of Technology Assessment in Health Care. 2002 ; Vol. 18, No. 3. pp. 497-507.
@article{d8659451881b46d2b012d85eb9f2bc8b,
title = "Clincal and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease",
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 pound2,415 savings to pound49,476 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.",
keywords = "Alzheimer's disease, cholinesterase inhibitors, review, PLACEBO-CONTROLLED TRIAL, RANDOMIZED CONTROLLED TRIAL, DOUBLE-BLIND, ECONOMIC-EVALUATION, GLOBAL FUNCTION, US MULTICENTER, DRUG-TREATMENT, HEALTH-CARE, EFFICACY, SAFETY",
author = "A. Clegg and J. Bryant and T. Nicholson and L. McIntyre and {de Broe}, S. and K. Gerard and Waugh, {Norman Robert}",
year = "2002",
doi = "10.1017/S026646230200034X",
language = "English",
volume = "18",
pages = "497--507",
journal = "International Journal of Technology Assessment in Health Care",
issn = "0266-4623",
publisher = "Cambridge University Press",
number = "3",

}

TY - JOUR

T1 - Clincal and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease

AU - Clegg, A.

AU - Bryant, J.

AU - Nicholson, T.

AU - McIntyre, L.

AU - de Broe, S.

AU - Gerard, K.

AU - Waugh, Norman Robert

PY - 2002

Y1 - 2002

N2 - 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 pound2,415 savings to pound49,476 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.

AB - 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 pound2,415 savings to pound49,476 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.

KW - Alzheimer's disease

KW - cholinesterase inhibitors

KW - review

KW - PLACEBO-CONTROLLED TRIAL

KW - RANDOMIZED CONTROLLED TRIAL

KW - DOUBLE-BLIND

KW - ECONOMIC-EVALUATION

KW - GLOBAL FUNCTION

KW - US MULTICENTER

KW - DRUG-TREATMENT

KW - HEALTH-CARE

KW - EFFICACY

KW - SAFETY

U2 - 10.1017/S026646230200034X

DO - 10.1017/S026646230200034X

M3 - Article

VL - 18

SP - 497

EP - 507

JO - International Journal of Technology Assessment in Health Care

JF - International Journal of Technology Assessment in Health Care

SN - 0266-4623

IS - 3

ER -