Institute of Health Care Management and Research, University of Duisburg-Essen, Essen, Germany.
Drugs. 2012 Apr 16;72(6):789-802. doi: 10.2165/11631830-000000000-00000.
Alzheimer's disease (AD) is common among the elderly; it is responsible for 60-80% of all dementia cases. AD is characterized by cognitive decline, behavioural and psychological symptoms, and reductions in functioning and independence. Because of its progressive neurodegenerative nature and unknown aetiology, the burden of AD becomes increasingly significant in an aging population. Estimates indicate that 35.6 million people worldwide suffered from AD in 2010. By 2030 and 2050, this figure is predicted to increase to 65.7 million and 115.4 million, respectively. Costs will also rise along with the increase in the number of people diagnosed with AD. In 2010, the worldwide costs associated with dementia were estimated to be $US604 billion.
The objective of this study was to conduct a systematic review of current publications dealing with the pharmacoeconomic factors associated with AD medications and to describe the decision-analytic models used to evaluate long-term outcomes.
A systematic literature search was performed to identify articles published between 1 January 2007 and 15 July 2010. The search was also based on a previous systematic review, which included literature up to 2007. Articles were included if they were complete and original economic evaluations of AD and if they were comparative in nature. A quality assessment of the included publications was conducted and relevant information was extracted into tables.
Seven out of 2067 identified articles were included in this systematic review. Four articles evaluated treatment with donepezil, one with galantamine and two with memantine. The studies were conducted in America, Europe and Asia. Five different groups of medications were compared. The incremental cost-effectiveness ratios (ICERs) for the group of patients treated with donepezil versus no drug treatment ranged from a dominant value to 281, 416.13 euros per quality-adjusted life-year (QALY). Patients treated with donepezil versus placebo showed ICERs with a range from a dominant value (not specified) up to 20, 866.77 euros per QALY. Treatment with memantine in addition to donepezil versus treatment with donepezil alone showed an ICER range from a dominant value to 6818.33 euros per QALY. In comparison with the memantine treatment as an add-on therapy, the ICER of memantine monotherapy versus standard care (without cholinesterase inhibitors [CEIs]) ranged from a dominant value to 63, 087.20 euros per QALY. Finally, the economic evaluation of galantamine in comparison with usual care without any AD drugs showed ICERs ranging from 1894.70 euros to 6953 euros per QALY.
The seven identified publications included in this review indicate that treatment with CEIs or memantine seems to be reasonable in terms of clinical effects and costs for patients with AD. Depending on different hypotheses, assumptions and variables (e.g. time horizon, discount rates, initial number of patients in different states, etc.) in the sensitivity analyses, treatment with these drugs seems to be primarily a cost-effective strategy or even a cost-saving strategy. Nevertheless, the results generally are associated with a degree of uncertainty. The comparability of the results from the different economic evaluations is limited because of the different assumptions made.
阿尔茨海默病（AD）在老年人中很常见；它占所有痴呆病例的 60-80%。AD 的特征是认知能力下降、行为和心理症状以及功能和独立性下降。由于其进行性神经退行性和未知病因，AD 的负担在人口老龄化中变得越来越重要。估计表明，2010 年全世界有 3560 万人患有 AD。到 2030 年和 2050 年，这一数字预计将分别增加到 6570 万和 1.154 亿。随着诊断出 AD 的人数增加，成本也将上升。2010 年，全世界与痴呆症相关的成本估计为 6040 亿美元。
本研究的目的是对目前与 AD 药物相关的药物经济学因素进行系统评价，并描述用于评估长期结果的决策分析模型。
进行了系统的文献检索，以确定 2007 年 1 月 1 日至 2010 年 7 月 15 日期间发表的文章。该搜索还基于之前的系统评价，其中包括截至 2007 年的文献。如果文章是关于 AD 的完整且原始的经济评估，并且具有可比性，则将其包括在内。对纳入的出版物进行了质量评估，并将相关信息提取到表格中。
在 2067 篇确定的文章中，有 7 篇被纳入本系统评价。四项研究评估了多奈哌齐的治疗效果，一项评估了加兰他敏的治疗效果，两项评估了美金刚的治疗效果。这些研究在美国、欧洲和亚洲进行。比较了五种不同的药物组。与未用药治疗相比，接受多奈哌齐治疗的患者的增量成本效益比（ICER）范围为从优势值到 281416.13 欧元/质量调整生命年（QALY）。与安慰剂相比，接受多奈哌齐治疗的患者的 ICER 范围从优势值（未指定）到 20866.77 欧元/QALY。与单独使用多奈哌齐相比，加兰他敏联合多奈哌齐治疗的 ICER 范围为从优势值到 6818.33 欧元/QALY。与美金刚作为附加治疗相比，美金刚单药治疗与标准护理（无胆碱酯酶抑制剂[CEIs]）的 ICER 范围为从优势值到 63087.20 欧元/QALY。最后，与常规护理（无 AD 药物）相比，加兰他敏的经济评估显示 ICER 范围为 1894.70 欧元至 6953 欧元/QALY。
本综述中纳入的七篇出版物表明，对于 AD 患者，使用 CEIs 或美金刚治疗在临床效果和成本方面似乎是合理的。根据不同的假设、假设和变量（例如时间范围、贴现率、不同状态的初始患者数量等）进行敏感性分析，这些药物的治疗似乎主要是一种具有成本效益的策略，甚至是一种节省成本的策略。然而，结果通常存在一定程度的不确定性。由于假设不同，不同经济评估的结果的可比性有限。
