Touchon Jacques, Lachaine Jean, Beauchemin Catherine, Granghaud Anna, Rive Benoit, Bineau Sébastien
Faculty of Medicine, University of Montpellier, Montpellier, France.
Eur J Health Econ. 2014 Nov;15(8):791-800. doi: 10.1007/s10198-013-0523-y. Epub 2013 Aug 9.
The costs associated with the care of Alzheimer's disease patients are very high, particularly those associated with nursing home placement. The combination of a cholinesterase inhibitor (ChEI) and memantine has been shown to significantly delay admission to nursing homes as compared to treatment with a ChEI alone. The objective of this cost-effectiveness analysis was to evaluate the economic impact of the concomitant use of memantine and ChEI compared to ChEI alone. Markov modelling was used in order to simulate transitions over time among three discrete health states (non-institutionalised, institutionalised and deceased). Transition probabilities were obtained from observational studies and French national statistics, utilities from a previous US survey and costs from French national statistics. The analysis was conducted from societal and healthcare system perspectives. Mean time to nursing home admission was 4.57 years for ChEIs alone and 5.54 years for combination therapy, corresponding to 0.98 additional years, corresponding to a gain in quality adjusted life years (QALYs) of 0.25. From a healthcare system perspective, overall costs were €98,609 for ChEIs alone and €90,268 for combination therapy, representing cost savings of €8,341. From a societal perspective, overall costs were €122,039 and €118,721, respectively, representing cost savings of €3,318. Deterministic and probabilistic (Monte Carlo simulations) sensitivity analyses indicated that combination therapy would be the dominant strategy in most scenarios. In conclusion, combination therapy with memantine and a ChEI is a cost-saving alternative compared to ChEI alone as it is associated with lower cost and increased QALYs from both a societal and a healthcare perspective.
与阿尔茨海默病患者护理相关的费用非常高，尤其是与入住养老院相关的费用。与单独使用胆碱酯酶抑制剂（ChEI）治疗相比，ChEI与美金刚联合使用已被证明可显著延迟入住养老院的时间。本成本效益分析的目的是评估美金刚与ChEI联合使用相对于单独使用ChEI的经济影响。采用马尔可夫模型来模拟三种离散健康状态（非机构化、机构化和死亡）随时间的转变。转移概率来自观察性研究和法国国家统计数据，效用值来自之前的美国调查，成本来自法国国家统计数据。该分析从社会和医疗保健系统的角度进行。单独使用ChEIs时，入住养老院的平均时间为4.57年，联合治疗为5.54年，多出0.98年，相当于质量调整生命年（QALY）增加了0.25。从医疗保健系统的角度来看，单独使用ChEIs的总体成本为98,609欧元，联合治疗为90,268欧元，节省成本8,341欧元。从社会角度来看，总体成本分别为122,039欧元和118,721欧元，节省成本3,318欧元。确定性和概率性（蒙特卡洛模拟）敏感性分析表明，在大多数情况下，联合治疗将是主导策略。总之，与单独使用ChEI相比，美金刚与ChEI联合治疗是一种节省成本的替代方案，因为从社会和医疗保健角度来看，它成本更低且QALY增加。
