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NICE Cost-Effectiveness Appraisal of Cholinesterase Inhibitors

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  • Denis Getsios
  • Kristen Migliaccio-Walle
  • Jaime Caro

Abstract

The National Institute for Health and Clinical Excellence (NICE) recently issued updated guidance on the use of cholinesterase inhibitors in the treatment of Alzheimer’s disease. NICE initially recommended that cholinesterase inhibitors no longer be used, but final guidance restricted treatment to patients with disease of a moderately severe stage. This decision was based largely on results from a heavily criticised economic evaluation that used an adaptation of the Assessment of Health Economics in Alzheimer’s Disease (AHEAD) model. As the developers of the AHEAD model, we examined the appropriateness of NICE’s economic analyses and presentation of results. We attempted to replicate NICE’s results by modifying the original AHEAD model. Sensitivity analyses were then run using the modified AHEAD model to evaluate the extent of uncertainty in predictions. The AHEADNICE analyses resulted in an incremental cost-effectiveness ratio for galantamine of £82 000 per QALY gained (year 2003 values) from the perspective of the UK NHS and Personal Social Services. This was later revised to £46 000 per QALY, compared with >£9000 per discounted QALY gained (year 2001 values) in the original AHEAD model. Using our modified AHEAD with effectiveness estimates matching those of AHEADNICE, we show that NICE’s choice and presentation of sensitivity analyses obscured the instability of their estimates. In the final NICE evaluation, the recommendation to delay treatment with cholinesterase inhibitors until patients have moderately severe disease was based on critical assumptions in the economic analyses that had little evidence to support them. The case of NICE’s guidance on cholinesterase inhibitors highlights the importance of transparent and valid economic evaluations and the dangers of using inappropriate modelling technologies, basing analyses on a limited subset of the available data, and insufficiently reflecting the uncertainty in estimates that are intended to inform decision makers. Copyright Adis Data Information BV 2007

Suggested Citation

  • Denis Getsios & Kristen Migliaccio-Walle & Jaime Caro, 2007. "NICE Cost-Effectiveness Appraisal of Cholinesterase Inhibitors," PharmacoEconomics, Springer, vol. 25(12), pages 997-1006, December.
    • Handle: RePEc:spr:pharme:v:25:y:2007:i:12:p:997-1006
    DOI: 10.2165/00019053-200725120-00003
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    References listed on IDEAS

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    1. A. E. Ades & Karl Claxton & Mark Sculpher, 2006. "Evidence synthesis, parameter correlation and probabilistic sensitivity analysis," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 373-381, April.
    2. Alan Brennan & Stephen E. Chick & Ruth Davies, 2006. "A taxonomy of model structures for economic evaluation of health technologies," Health Economics, John Wiley & Sons, Ltd., vol. 15(12), pages 1295-1310, December.
    3. Nick Bosanquet & Andrew Yeates, 2006. "Modelling the Cost Effectiveness of Cholinesterase Inhibitors in the Management of Mild to Moderately Severe Alzheimer’s Disease," PharmacoEconomics, Springer, vol. 24(6), pages 623-625, June.
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    Cited by:

    1. 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.
    2. Denis Getsios & Steve Blume & K. Ishak & Grant Maclaine, 2010. "Cost Effectiveness of Donepezil in the Treatment of Mild to Moderate Alzheimer’s Disease," PharmacoEconomics, Springer, vol. 28(5), pages 411-427, May.
    3. Kristin Kahle-Wrobleski & Howard Fillit & Jonathan Kurlander & Catherine Reed & Mark Belger, 2015. "Methodological challenges in assessing the impact of comorbidities on costs in Alzheimer’s disease clinical trials," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(9), pages 995-1004, December.
    4. Eric Stallard & Bruce Kinosian & Arthur S. Zbrozek & Anatoliy I. Yashin & Henry A. Glick & Yaakov Stern, 2010. "Estimation and Validation of a Multiattribute Model of Alzheimer Disease Progression," Medical Decision Making, , vol. 30(6), pages 625-638, November.
    5. Dixon, Josie & Ferdinand, Monique & D'Amico, Francesco & Knapp, Martin, 2015. "Exploring the cost-effectiveness of a one-off screen for dementia (for people aged 75 years in England and Wales)," LSE Research Online Documents on Economics 58109, London School of Economics and Political Science, LSE Library.

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