Caro J Jaime, Salas Maribel, Ward Alexandra, Getsios Denis, Mehnert Angelika
Caro Research Institute, Boston, Mass., USA.
Dement Geriatr Cogn Disord. 2002;14(2):84-9. doi: 10.1159/000064929.
The economic impact of dementia on the Dutch health and social services is substantial.
To predict the long-term economic impact of galantamine, a cholinesterase inhibitor, in the treatment of Dutch patients with mild to moderate Alzheimer's disease.
A pharmacoeconomic model was used to predict long-term outcomes. It has two components: an initial module based on clinical trials of galantamine and a subsequent module that predicts when a patient will deteriorate to a level where full time care (FTC) is needed. The analyses take a broad perspective that includes all formal (paid) care, not just those covered by the Dutch health care system. Direct cost estimates were based on resource use profiles of patients with Alzheimer's disease in the Netherlands. Key inputs were tested in sensitivity analyses.
After 10.5 years all patients are predicted to require FTC. For every hundred patients starting treatment on galantamine at the mild to moderate stage, it is predicted that 18 person-years of FTC will be avoided (14.4 discounted) and about 5 quality-adjusted years of life will be gained (3.9 discounted). Net savings for those starting treatment with galantamine are estimated at NLG 3,050 (1,676 UDS). The cost of galantamine accounts for only about 5.0% of the total cost of care for treated Alzheimer's patients. The direction of these results remained unchanged when input values and assumptions were tested in sensitivity analyses.
The cholinesterase inhibitor galantamine is expected to bring savings in the direct cost of caring for patients with Alzheimer's disease in the Netherlands.
痴呆症对荷兰卫生和社会服务的经济影响巨大。
预测胆碱酯酶抑制剂加兰他敏治疗荷兰轻至中度阿尔茨海默病患者的长期经济影响。
采用药物经济学模型预测长期结果。该模型有两个组成部分：一个基于加兰他敏临床试验的初始模块，以及一个预测患者何时会恶化到需要全职护理（FTC）水平的后续模块。分析采用广泛的视角，包括所有正式（付费）护理，而不仅仅是荷兰医疗保健系统覆盖的护理。直接成本估计基于荷兰阿尔茨海默病患者的资源使用情况。关键输入值在敏感性分析中进行了测试。
预计10.5年后所有患者都需要全职护理。对于每百名在轻至中度阶段开始接受加兰他敏治疗的患者，预计可避免18人年的全职护理（贴现后为14.4人年），并可获得约5个质量调整生命年（贴现后为3.9个）。开始使用加兰他敏治疗的患者的净节省估计为3050荷兰盾（1676美元）。加兰他敏的成本仅占接受治疗的阿尔茨海默病患者护理总成本的约5.0%。在敏感性分析中测试输入值和假设时，这些结果的方向保持不变。
胆碱酯酶抑制剂加兰他敏预计将为荷兰阿尔茨海默病患者的护理直接成本带来节省。
