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The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer’s disease to nursing homes: cost-effectiveness analysis in France

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  • Jacques Touchon
  • Jean Lachaine
  • Catherine Beauchemin
  • Anna Granghaud
  • Benoit Rive
  • Sébastien Bineau

Abstract

The costs associated with the care of Alzheimer’s disease patients are very high, particularly those associated with nursing home placement. The combination of a cholinesterase inhibitor (ChEI) and memantine has been shown to significantly delay admission to nursing homes as compared to treatment with a ChEI alone. The objective of this cost-effectiveness analysis was to evaluate the economic impact of the concomitant use of memantine and ChEI compared to ChEI alone. Markov modelling was used in order to simulate transitions over time among three discrete health states (non-institutionalised, institutionalised and deceased). Transition probabilities were obtained from observational studies and French national statistics, utilities from a previous US survey and costs from French national statistics. The analysis was conducted from societal and healthcare system perspectives. Mean time to nursing home admission was 4.57 years for ChEIs alone and 5.54 years for combination therapy, corresponding to 0.98 additional years, corresponding to a gain in quality adjusted life years (QALYs) of 0.25. From a healthcare system perspective, overall costs were €98,609 for ChEIs alone and €90,268 for combination therapy, representing cost savings of €8,341. From a societal perspective, overall costs were €122,039 and €118,721, respectively, representing cost savings of €3,318. Deterministic and probabilistic (Monte Carlo simulations) sensitivity analyses indicated that combination therapy would be the dominant strategy in most scenarios. In conclusion, combination therapy with memantine and a ChEI is a cost-saving alternative compared to ChEI alone as it is associated with lower cost and increased QALYs from both a societal and a healthcare perspective. Copyright The Author(s) 2014

Suggested Citation

  • Jacques Touchon & Jean Lachaine & Catherine Beauchemin & Anna Granghaud & Benoit Rive & Sébastien Bineau, 2014. "The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer’s disease to nursing homes: cost-effectiveness analysis in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 791-800, November.
    • Handle: RePEc:spr:eujhec:v:15:y:2014:i:8:p:791-800
    DOI: 10.1007/s10198-013-0523-y
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    References listed on IDEAS

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    1. Denis Getsios & Kristen Migliaccio-Walle & Jaime Caro, 2007. "NICE Cost-Effectiveness Appraisal of Cholinesterase Inhibitors," PharmacoEconomics, Springer, vol. 25(12), pages 997-1006, December.
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    Cited by:

    1. L. M. Peña-Longobardo & B. Rodríguez-Sánchez & J. Oliva-Moreno & I. Aranda-Reneo & J. López-Bastida, 2019. "How relevant are social costs in economic evaluations? The case of Alzheimer’s disease," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(8), pages 1207-1236, November.
    2. Mark Belger & Josep Maria Haro & Catherine Reed & Michael Happich & Josep Maria Argimon & Giuseppe Bruno & Richard Dodel & Roy W. Jones & Bruno Vellas & Anders Wimo, 2019. "Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer’s disease dementia," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 343-355, April.

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    More about this item

    Keywords

    Alzheimer’s disease; Cholinesterase inhibitors; Memantine; Cost-effectiveness; Nursing home admission; D61; I10; I12; I18;
    All these keywords.

    JEL classification:

    • D61 - Microeconomics - - Welfare Economics - - - Allocative Efficiency; Cost-Benefit Analysis
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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