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ABSTRACT
Introduction: Alzheimer’s disease (AD) results in progressively worsening cognitive decline, leading to loss of functional ability, behavior/mood disturbances, institutionalization, and death. Current pharmaceutical therapies only treat the symptoms of cognitive decline yet can be expensive for payers.
Areas covered: The authors undertook a systematic review of economic evaluations of pharmaceutical therapies for AD. The literature search encompassed English-language studies indexed in PubMed (Medline), Cochrane Library Current, and Web of Science. The search included articles published between 1 January 1995 and 10 February 2018. The literature suggested AD medications generally dominated comparator treatments (e.g. placebo).
Expert opinion: The authors noted several limitations of the included economic evaluations. These limitations suggest the results of the economic evaluations should be interpreted with caution. Many economic models were not transparent with respect to sources of probabilities and cost data, and data collected in certain jurisdictions were applied to other jurisdictions without considering the validity of such applications. Measuring health utilities in cognitively impaired populations raises questions about the validity of quality-adjusted life years, but this issue was unaddressed in the included studies. Most included studies were sponsored by industry and the results tended to overwhelmingly support the manufacturer’s product.
Article highlights
The literature shows AD medications generally dominate comparator treatments (e.g. placebo).
This finding should be interpreted with caution given the limitations of the included studies.
The limitations include an absence of model transparency in the selection and use of probabilities and cost data, possible sampling bias, and the use of proxies to calculate health utilities.
Twenty-four of the 28 industry-funded studies included in the review reported that AD medications dominated comparator treatments, which suggests possible publication bias.
The existing literature portrays an overly optimistic picture of the cost-effectiveness of AD medications.
This box summarizes key points contained in the article.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acronym list
| AD: | = | Alzheimer’s disease |
| ADAS-cog: | = | Alzheimer’s Disease Assessment Scale – Cognitive |
| AdViSHE: | = | A Validation-Assessment Tool of Health-Economic Models for Decision Makers and Model Users |
| AHEAD: | = | Assessment of Health Economics in Alzheimer’s Disease |
| BSC: | = | Best supportive care |
| CCA: | = | Cost-consequence approach |
| CDR: | = | Clinical Dementia Rating |
| CEA: | = | Cost-effectiveness approach |
| CHEC: | = | Consensus Health Economic Criteria |
| ChEI: | = | Cholinesterase inhibitor |
| CMA: | = | Cost-minimization approach |
| CUA: | = | Cost-utility approach |
| ECOBIAS: | = | Bias in Economic Evaluation Checklist |
| EQ-5D: | = | EuroQol Five-Dimensional |
| FDA: | = | U.S. Food and Drug Association |
| FTC: | = | Full-time care |
| HRQoL: | = | Health-related quality of life |
| HUI: | = | Healthy Utility Index |
| ICER: | = | Incremental Cost-Effectiveness Ratio |
| MeSH: | = | Medical Subject Headings |
| MMSE: | = | Mini-Mental State Examination |
| NICE: | = | National Institute of Clinical Excellence (UK) |
| PRISMA: | = | Preferred Reporting Items for Systematic review and Meta-Analysis |
| QALY: | = | Quality-adjusted life years |
| RCT: | = | Randomized control trial |
| RRR: | = | Relative risk reduction |