Wong Camilla L, Bansback Nick, Lee Philip E, Anis Aslam H
Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada.
Can J Neurol Sci. 2009 Nov;36(6):735-9. doi: 10.1017/s0317167100008350.
Several randomized controlled trials of cholinesterase inhibitors and memantine in mild to moderate vascular dementia have demonstrated the efficacy of these treatments. However, given these drugs incur considerable cost, the economic argument for their use is less clear.
To determine the incremental cost-effectiveness of cholinesterase inhibitors and memantine for mild to moderate vascular dementia.
A decision analysis model using a 24-28 week time horizon was developed. Outcomes of cholinesterase inhibitors and memantine and probabilities of adverse events were extracted from a systematic review. Costs of adverse events, medications, and physician visits were obtained from local estimates. Robustness was tested with probabilistic sensitivity analysis using a Monte Carlo simulation.
Donepezil 5 mg daily, donepezil 10 mg daily, galantamine 16-24 mg daily, rivastigmine flexible dosing up to 6 mg twice daily, or memantine 10 mg twice daily versus standard care.
Incremental cost-effectiveness ratio (ICER) expressed as cost per unit decrease in the Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) subscale.
Donepezil 10 mg daily was found to be the most cost-effective treatment with an ICER of $400.64 (95%CI, $281.10-$596.35) per unit decline in the ADAS-cog subscale. All other treatments were dominated by donepezil 10 mg, that is, more costly and less effective.
From a societal perspective, treatment with cholinesterase inhibitors or memantine was more effective but also more costly than standard care for mild to moderate vascular dementia. The donepezil 10 mg strategy was the most cost-effective and also dominated the other alternatives.
多项关于胆碱酯酶抑制剂和美金刚用于轻至中度血管性痴呆的随机对照试验已证明了这些治疗方法的有效性。然而，鉴于这些药物成本高昂，其使用的经济学依据尚不明晰。
确定胆碱酯酶抑制剂和美金刚用于轻至中度血管性痴呆的增量成本效果。
开发了一个使用24 - 28周时间范围的决策分析模型。从一项系统评价中提取了胆碱酯酶抑制剂和美金刚的疗效以及不良事件的概率。不良事件、药物和医生诊疗的成本来自当地估计值。通过使用蒙特卡洛模拟的概率敏感性分析来测试稳健性。
每日5毫克多奈哌齐、每日10毫克多奈哌齐、每日16 - 24毫克加兰他敏、每日两次灵活剂量最高达6毫克的卡巴拉汀，或每日两次10毫克美金刚与标准治疗进行对比。
以阿尔茨海默病评估量表认知（ADAS - cog）子量表每单位下降的成本表示的增量成本效果比（ICER）。
发现每日10毫克多奈哌齐是最具成本效益的治疗方法，ADAS - cog子量表每下降一个单位的ICER为400.64美元（95%CI，281.10美元 - 596.35美元）。所有其他治疗方法均被每日10毫克多奈哌齐所主导，即成本更高且效果更差。
从社会角度来看，对于轻至中度血管性痴呆，胆碱酯酶抑制剂或美金刚治疗比标准治疗更有效，但成本也更高。每日10毫克多奈哌齐策略是最具成本效益的，并且也优于其他替代方案。
