Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer’s type in the US

Abstract

Objective:

This study evaluates the cost-effectiveness of memantine extended release (ER) as an add-on therapy to acetylcholinesterase inhibitor (AChEI) [combination therapy] for treatment of patients with moderate-to-severe Alzheimer’s disease (AD) from both a healthcare payer and a societal perspective over 3 years when compared to AChEI monotherapy in the US.

Methods:

A phase III trial evaluated the efficacy and safety of memantine ER for treatment of AD patients taking an AChEI. The analysis assessed the long-term costs and health outcomes using an individual patient simulation in which AD progression is modeled in terms of cognition, behavior, and functioning changes. Input parameters are based on patient-level trial data, published literature, and publicly available data sources. Changes in anti-psychotic medication use are incorporated based on a published retrospective cohort study. Costs include drug acquisition and monitoring, total AD-related medical care, and informal care associated with caregiver time. Incremental cost-utility ratio (ICUR), life years, care time for caregiver, time in community and institution, time on anti-psychotics, time by disease severity, and time without severe symptoms are reported. Costs and health outcomes are discounted at 3% per annum.

Results:

Considering a societal perspective over 3 years, this analysis shows that memantine ER combined with an AChEI provides better clinical outcomes and lower costs than AChEI monotherapy. Discounted average savings were estimated at $18,355 and $20,947 per patient and quality-adjusted life-years (QALYs) increased by an average of 0.12 and 0.13 from a societal and healthcare payer perspective, respectively. Patients on combination therapy spent an average of 4 months longer living at home and spend less time in moderate–severe and severe stages of the disease.

Conclusion:

Combination therapy for patients with moderate-to-severe AD is a cost-effective treatment compared to AChEI monotherapy in the US.

Keywords::

• Acetylcholinesterase inhibitors
• Alzheimer’s disease
• Cost
• Cost-benefit analysis
• Dementia
• Effectiveness
• Memantine

Transparency

Declaration of funding

Funding for this study was provided by Forest Research Institute, an affiliate of Actavis.

Declaration of financial/other relationships

CSLT, IÖS, DG, IP, and LH are employees of Evidera, Inc., an independent research organization that received consulting fees from Forest Research Institute for the development of this paper. SD is an employee of Forest Research Institute, the manufacturer of memantine ER. SC, a previous employee of Forest Research Institute at the time of this research project, is now an employee of AstraZeneca.

Acknowledgments

The authors would like to acknowledge Andrea Kress and Rodrigo Dos Santos from Evidera, as well as Abhilasha Ramasamy from Forest Research Institute for their support to improve the writing of this manuscript.

Previous presentation

Presented at the Alzheimer’s Associate International Conference, Copenhagen, Denmark, July 12–17, 2014.

Supplementary material available online

Supplementary Information Figures S1-S3