FDA-approved medications for dementia are unlike non-pharmacological interventions as they are counterproductive

ABSTRACT

Recently, a number of non-pharmacological interventions for dementia symptoms were evaluated using cost–benefit analysis (CBA) and found to be both effective and socially worthwhile. What is missing is a comparison of evaluations for these interventions with pharmaceutical interventions approved by the Food and Drug Administration (FDA) to see which interventions should be given priority in public expenditure budgets aiming to reduce dementia symptoms. This paper fills this knowledge gap by carrying out a CBA of FDA-approved medications using a large national data set provided by the National Alzheimer’s Coordinating Center (NACC). We find that the pharmaceutical medications were actually counterproductive, and therefore social welfare would be substantially improved by not investing in these medications. This therefore means that non-pharmaceutical interventions should be given higher priority at this time.

KEYWORDS:

• FDA-approved medications
• non-pharmaceutical interventions
• dementia
• cost–benefit analysis
• value of a statistical life

JEL CLASSIFICATION:

• I12
• J14

Acknowledgments

The NACC database is funded by NIA/NIH Grant U01 AG016976. NACC data are contributed by the NIA-funded ADCs: P30 AG019610 (PI Eric Reiman, MD), P30 AG013846 (PI Neil Kowall, MD), P50 AG008702 (PI Scott Small, MD), P50 AG025688 (PI Allan Levey, MD, PhD), P30 AG010133 (PI Andrew Saykin, PsyD), P50 AG005146 (PI Marilyn Albert, PhD), P50 AG005134 (PI Bradley Hyman, MD, PhD), P50 AG016574 (PI Ronald Petersen, MD, PhD), P50 AG005138 (PI Mary Sano, PhD), P30 AG008051 (PI Steven Ferris, PhD), P30 AG013854 (PI M. Marsel Mesulam, MD), P30 AG008017 (PI Jeffrey Kaye, MD), P30 AG010161 (PI David Bennett, MD), P30 AG010129 (PI Charles DeCarli, MD), P50 AG016573 (PI Frank LaFerla, PhD), P50 AG016570 (PI David Teplow, PhD), P50 AG005131 (PI Douglas Galasko, MD), P50 AG023501 (PI Bruce Miller, MD), P30 AG035982 (PI Russell Swerdlow, MD), P30 AG028383 (PI Linda Van Eldik, PhD), P30 AG010124 (PI John Trojanowski, MD, PhD), P50 AG005133 (PI Oscar Lopez, MD), P50 AG005142 (PI Helena Chui, MD), P30 AG012300 (PI Roger Rosenberg, MD), P50 AG005136 (PI Thomas Montine, MD, PhD), P50 AG033514 (PI Sanjay Asthana, MD, FRCP), P50 AG005681 (PI John Morris, MD) and P50 AGO047270 (PI Stephen Strittmatter, MD, PhD).

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ In total, there were three misconceptions concerning dementia: what it is, what can be done, and what should be done, see Brent (2021).

² My thanks go to the referee of this journal for pointing this out to me.

³ This is the so called ‘incidental parameters problem’, Wooldridge (2002).

⁴ We will actually be excluding hearing aids from the set of new interventions to explain mortality because, as we shall see, it was insignificant in explaining dementia symptoms in our restricted data set, and it would only serve to greatly reduce the sample size.

⁵ See Perneczky et al., op cit., and Brent (2022a), chapter 2.

⁶ The 5.09 million USD figure was obtained from Aldy and Viscusi (2008).

⁷ For example, for the donepezil-memantine combination the cost was 89,932 USD, and therefore higher than for any of the monotherapies.

⁸ Coefficient estimates in Table 6 are much more significant than in Table 4, with all the estimates significant well below the 1% level. This occurs no matter which column is used, unlike the regression results where the choice of the set of control variables was decisive in determining significance.

⁹ See Brent (2022a), op cit. In the book, two other dementia interventions were subject to a CBA. They were a multiservice intervention to reduce elder abuse and cognitive rehabilitation, which was designated to be a human right by the United Nations for those with dementia. These two interventions were also found to be effective and socially worthwhile. These interventions confirm our overall assessment, that it is not correct to say that nothing can be done to reduce dementia symptoms at this time.