Jönsson Linus
Stockholm Health Economics, Stockholm, Sweden.
Am J Geriatr Pharmacother. 2005 Jun;3(2):77-86. doi: 10.1016/j.amjopharm.2005.05.002.
Alzheimer's disease entails enormous costs for society and impairs quality of life for patients and caregivers.
This study estimated the cost-effectiveness of memantine in the treatment of patients with moderately severe to severe cognitive impairment from Alzheimer's disease in Sweden.
The study was based on published data from several sources, including a randomized controlled trial of memantine versus placebo and a longitudinal observational study of Alzheimer's disease patients in Sweden. Costs were estimated from the public payer's perspective, including direct costs but excluding costs of informal care, and resource utilization data were taken from the observational study. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from treatment with the use of previously published utility weights. A Markov simulation model was constructed, incorporating the effect of treatment on cognitive function, physical dependence related to activities of daily living, and institutionalization. Costs and effects for treated and untreated patients were estimated for 5 years (10 cycles). In the base-case analysis, treatment costs were added for 2 years, but the effect on transition probabilities was applied only for the first year of treatment.
Compared with no treatment, memantine treatment was predicted to be associated with lower costs of care, longer time to dependence and institutionalization, and gains in QALYs. Treatment was estimated to decrease formal care costs by 123,600 Swedish kronor (SEK) and, after taking into account the cost of memantine, to lead to net cost savings of 100,528 SEK per patient. Treated patients gained 0.148 QALY over the 5-year simulation.
From a public payer's perspective, the observed effect of memantine on cognitive and physical function is predicted to translate into economic benefits that offset the added treatment cost. Treatment is also predicted to delay institutionalization, improve independence, and increase QALYs.
阿尔茨海默病给社会带来巨大成本，并损害患者及照料者的生活质量。
本研究评估了美金刚在瑞典治疗中重度至重度阿尔茨海默病认知障碍患者的成本效益。
该研究基于多个来源的已发表数据，包括一项美金刚与安慰剂的随机对照试验以及瑞典阿尔茨海默病患者的纵向观察性研究。成本从公共支付方的角度进行估算，包括直接成本但不包括非正式照料成本，资源利用数据取自观察性研究。成本效益通过使用先前发表的效用权重从治疗中获得的质量调整生命年（QALYs）进行量化。构建了一个马尔可夫模拟模型，纳入了治疗对认知功能、与日常生活活动相关的身体依赖以及机构化的影响。对治疗和未治疗患者的成本和效果进行了5年（10个周期）的估算。在基础案例分析中，增加了2年的治疗成本，但对转移概率的影响仅应用于治疗的第一年。
与未治疗相比，预计美金刚治疗可降低护理成本、延长至依赖和机构化的时间，并增加QALYs。估计治疗可使正式护理成本降低123,600瑞典克朗（SEK），在考虑美金刚成本后，每位患者可实现净成本节约100,528瑞典克朗。在5年模拟期内，接受治疗的患者获得了0.148个QALY。
从公共支付方的角度来看，预计美金刚对认知和身体功能的观察效果将转化为经济效益，抵消额外的治疗成本。预计治疗还可延迟机构化、提高独立性并增加QALYs。
