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Teipel, S.J.* ; Ewers, M.* ; Reisig, V. ; Schweikert, B. ; Hampel, H.* ; Happich, M.

Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease.

Eur. Arch. Psychiatry Clin. Neurosci. 257, 330-336 (2007)
DOI PMC
Open Access Green as soon as Postprint is submitted to ZB.
Acetyl-)cholinesterase (ChE) inhibitors have been approved for the treatment of mild to moderate Alzheimer's disease (AD). However, use of ChE inhibitors is limited by budget constraints and disincentives on the side of health insurances and nursing care insurances. OBJECTIVE: To analyse under what conditions the application of the acetylcholinesterase inhibitor donepezil is favourable for the treatment of patients with AD from the perspective of health insurance and nursing care insurance companies in Germany, taking into account factors such as start and duration of treatment, duration of follow-up, drug costs, internalization of opportunity costs and varying mortality and efficacy rates. METHODS: Transition probabilities from a Swedish study and German cost data for donepezil were merged in a Markov model to follow a cohort of patients over a period of 5-10 years. We defined a base case with 1 year treatment and follow-up over 5 years and varied treatment length, follow-up interval and cost factors in sensitivity analyses. RESULTS: In the base case, the ChE inhibitor donepezil did not lead to cost savings but to a cost-effective outcome on side of health insurances and nursing care insurances. Early treatment of AD and internalization of opportunity costs (caring time devoted to patients) led to less costs per quality adjusted life years gained. However, results are very sensitive with respect to varying mortality and efficacy rates. CONCLUSION: The application of donepezil may be cost-effective, but considerable uncertainties remain. Moreover, the way the reimbursement system in Germany is presently arranged does not support the application of ChE inhibitors.
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Publication type Article: Journal article
Document type Scientific Article
Keywords cost-effectiveness; ChE inhibitors; Alzheimer’s disease; quality of life; mortality
ISSN (print) / ISBN 0940-1334
e-ISSN 1433-8491
Journal European Archives of Psychiatry and Clinical Neuroscience
Quellenangaben Volume: 257, Issue: 6, Pages: 330-336 Article Number: , Supplement: ,
Publisher Springer
Reviewing status Peer reviewed
Institute(s) Institute of Health Economics and Health Care Management (IGM)