Wimo Anders
Division of Geriatric Epidemiology, Neurotec, Karolinska Institutet, Stockholm, Sweden.
Drugs Aging. 2004;21(5):279-95. doi: 10.2165/00002512-200421050-00001.
Cholinesterase inhibitors have been available for the treatment of Alzheimer's disease since 1993. They have significantly positive effects on cognitive functioning and other domains of functional capacity, such as activities of daily life in terms of efficacy, but the clinical value of these effects are under discussion. Cholinesterase inhibitors may also influence behavioural and psychological symptoms in Alzheimer's disease. Cholinesterase inhibitors are also regarded as rather expensive and, therefore, the question of cost effectiveness is essential. Pharmacoeconomic evaluations of cholinesterase inhibitors have so far been conducted in retrospect on efficacy data from prospective randomised clinical trials combined with economic data from other sources. There are no published specific cost-effectiveness studies of cholinesterase inhibitors which prospectively collected empirical data on costs and outcomes. There is only one published randomised clinical trial with such empirical data with a cost consequence analysis design, indicating cost neutrality. Several types of models to describe the long-term effects have been published, indicating cost effectiveness. However, due to methodological considerations, the validity of these models is difficult to judge. A research agenda for the cost effectiveness of cholinesterase inhibitors is proposed, including long-term studies with empirical data on resource use, costs and outcomes, studies on quality of life, informal care and behavioural and psychological symptoms, combination and comparative studies on mild cognitive impairment.
自1993年以来，胆碱酯酶抑制剂一直用于治疗阿尔茨海默病。就疗效而言，它们对认知功能以及功能能力的其他方面，如日常生活活动，具有显著的积极作用，但这些作用的临床价值仍在讨论中。胆碱酯酶抑制剂也可能影响阿尔茨海默病的行为和心理症状。胆碱酯酶抑制剂也被认为相当昂贵，因此，成本效益问题至关重要。到目前为止，胆碱酯酶抑制剂的药物经济学评估是回顾性地对前瞻性随机临床试验的疗效数据与其他来源的经济数据进行的。目前尚无已发表的关于胆碱酯酶抑制剂的具体成本效益研究，这些研究前瞻性地收集了关于成本和结果的实证数据。只有一项已发表的具有此类实证数据的随机临床试验采用了成本后果分析设计，表明成本中性。已经发表了几种描述长期效果的模型，表明具有成本效益。然而，由于方法学上的考虑，这些模型的有效性难以判断。本文提出了胆碱酯酶抑制剂成本效益的研究议程，包括对资源使用、成本和结果进行实证数据的长期研究、关于生活质量、非正式护理以及行为和心理症状的研究、轻度认知障碍的联合研究和比较研究。
