Memantine for treatment of moderate or severe Alzheimer’s disease patients in urban China: clinical and economic outcomes from a health economic model

Abstract

Objective: To estimate the clinical and economic benefits of memantine treatment initiated in moderate Alzheimer’s disease (AD) in China, compared with initiation in severe AD only. Methods: A Markov model with a 5-year time horizon simulated moderate patients’ progression through health states. Two groups were compared: patients receiving memantine from the moderate stage (i.e., at model entry), continuing treatment when reaching the severe stage; patients initiating memantine only when they developed severe disease. Results: After 5 years, fewer patients receiving memantine from the moderate stage were severe (49%), dependent (59%) or aggressive (47%) compared with moderate patients who initiated treatment from severe stage only (58, 67 and 55%, respectively). Total cost of care was lower for treatment from moderate stage (67 billion RMB) when compared with treatment from severe stage (73 billion RMB). Conclusions: In China, AD treatment with memantine from the moderate stage could result in substantial cost savings.

Keywords:

• aggression
• Alzheimer’s disease
• cost-saving
• disease burden
• memantine
• pharmacoeconomic

Acknowledgements

The authors would like to thank the participants of the Delphi panel for their input into the draft model specifications, on which the final model was based. The authors acknowledge Costello Medical Singapore Pte. Ltd. for editorial and administrative assistance.

Financial & competing interest disclosures

This study was funded by H Lundbeck A/S. E Clay is an employee of Creativ-Ceutical. M Toumi is the Chief Scientific Officer of Creativ-Ceutical. D Milea is an employee of Lundbeck Pte Ltd. The authors have no other 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 apart from those disclosed.

Key issues

• Alzheimer’s disease (AD) is the most common cause of dementia in China. As the cost of AD-related care represents a substantial and growing economic burden in China, it is crucial to identify treatments that can delay symptom progression and reduce the economic impact of advanced disease.

• Memantine, an N-methyl-D-aspartate receptor antagonist, has been shown to promote functional improvement as well as to reduce dependence and deterioration in patients with moderate to severe AD. In China, memantine is approved for treating moderate-to-severe AD patients, but reimbursement is currently recommended for severe AD only.

• We developed a model to assess clinical and economic outcomes of memantine treatment when initiated in moderate AD patients in China, compared with memantine initiation in severe patients.

• After 5 years, fewer AD patients receiving memantine from the moderate stage were severe (49%), dependent (59%) or aggressive (47%), compared with moderate patients who initiated treatment from severe stage only (58, 67 and 55%, respectively). Total cost of care was lower for treatment from the moderate stage (67 billion RMB), compared with treatment from the severe stage (73 billion RMB).

• Initiating memantine in the moderate stage of AD and thereby alleviating AD symptoms could achieve substantial cost savings in China compared with initiating memantine when patients reach the severe stage.

Notes

*The Delphi panel consisted of: Professor Chen Shengdi (Shanghai Ruijin Hospital Neurology Department), Professor Yu Xin (Beijing Mental Health Institute Geriatric Psychiatry), Professor Jia Jianjun (Beijing 301 Hospital Neurology department), Professor Chen Xiaochun (Fu Jian Medical School Xiehe Hospital), Director Li Chunhou (PUMCH Medical Insurance/Reimbursement Office) and Liu Cong (Beijing TongRen Hospital Medical Insurance/Reimbursement Office)