Affiliations: [a] Evaluation and Planning Unit, Canary Islands Health Service, Spain | [b] University Hospital Nuestra Señora de la Candelaria, Canary Islands Health Service, Spain | [c] CIBER Epidemiología y Salud Pública (CIBERESP), Spain | [d] EcoStat Consulting UK, London, UK | [e] Canary Islands Foundation for Health and Research (FUNCIS), Spain
Correspondence:
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Corresponding author: Julio López-Bastida, C/ Pérez de Rozas, n° 5, 4a planta, 38004 Santa Cruz de Tenerife, Canary Islands, Spain. Tel.: +34 922 47 57 58; Fax: +34 922 47 57 51; E-mail: jlopbas@gobiernodecanarias.org.
Abstract: Available treatments for Alzheimer's disease (AD) need to be evaluated in order to determine whether the clinical benefits justify their additional costs. This study evaluated the cost-effectiveness of donepezil treatment compared with no-drug treatment of mild and moderate AD from the perspective of society and the health care system in Spain. A Markov model was designed to simulate the natural history of a cohort of patients with mild and moderate AD. Monthly transition probabilities were estimated from the international literature and donepezil clinical trials. Direct medical and non-medical costs and utilities were derived from Spanish studies. Local data on tolerance and medication withdrawal rates were incorporated into the model. Incremental cost-effectiveness ratios for a range of realistic treatment options were calculated. A probabilistic sensitivity analysis was carried out using a Monte Carlo approach with 10,000 iterations. In the baseline scenario (24 months, patients initially with mild AD) incremental cost-effectiveness for direct medical costs was 20,353 eur/QALY. When all costs were taken into account, donepezil treatment was the dominant strategy. Incremental cost-effectiveness ratios vary according to the selected perspective. For the baseline scenario, donepezil treatment is cost-effective with a probability of 95% for a threshold efficiency of 25,000 eur/QALY.
Keywords: Alzheimer's disease, cost-effectiveness, donepezil, modeling, quality of life
