Economic considerations in the management of Alzheimer’s disease

Figures & data

Table 1 Cognitive, functional and behavioral deficits by disease stage in Alzheimer’s disease

Domain	MCI	Mild AD	Moderate AD	Severe AD
Duration	3–5 yrs	1–2 yrs	2–12 yrs	1 yr
Cognitive	Memory impairment (isolated deficit)	Recall/Learning	Moderate memory loss	Severe memory loss
		Word finding difficulty	Anomia	Agnosia
		Judgment and problem solving	Visuospatial deficits	Apraxia
		Calculation impairment	Disorientation
			Confusion
Functional	Occasional loss of complex social or occupational skills	Difficulty in: Routine chores	Loss of IADL	Loss of basic ADL: Dressing
			Getting lost
		Complex meal preparation	Difficulty dressing	Grooming/bathing
		Financial matters	Poor eating habits	Eating
		Hobbies	Poor hygiene habits	Continence
				Mobility
Behavioral	Apathy, Irritability Withdrawal (mild)	Apathy	Agitation	Agitation:
		Delusions	Delusions	Verbal
		Depression	Depression	Physical
		Withdrawal (moderate)	Insomnia	Insomnia
			Wandering

Abbreviations: AD, Alzheimer’s disease; IADL, instrumental activities of daily living; MCI, mild cognitive impairment.

Table 2 Pharmacoeconomic studies with approved treatments for Alzheimer’s disease

Study type	Author	Drug studied	Study length	Costs included	AD severity	Per patient cost savings	Country
RCT	Courtney et al 2004	Donepezil	5 yrs	Direct medical cost and cost of caregiver time	Mild to moderate	No cost difference	UK
RCT	Feldman et al 2004	Donepezil	24 wks	Patient and caregiver direct medical cost, and cost of caregiver time	Moderate to severe	Direct medical cost: US$21; informal care cost: US$265	Canada
RCT	Sano et al 2003	Galantamine	6 months	Cost of caregiver time	Mild to moderate	32 minutes per day	US
RCT	Wimo, Winblad, Stoffler, et al 2003	Memantine	28 wks	Direct medical cost and cost of caregiver time	Moderate to severe	Direct medical cost: US$1090 per month; caregiving time: 51.5 hrs per month	US
Matched-controlled	Small et al 1998	Donepezil	6 months	Direct medical costs	Not specified	No cost difference	US
Matched-controlled	Hill et al 2002	Donepezil	12 months	Direct medical costs	Not specified	US$3891	US
Pre-post design	Fillit et al 1999	Donepezil	Pre-treatment: 15 months Post-treatment: 7 months	Direct medical costs	Not specified	US$2.11 higher per day	US
Modeling study	Stewart et al 1998	Donepezil	Markov, 5 yrs	Direct medical costs	Mild to moderate	No cost difference	UK
Modeling study	Neumann et al 1999	Donepezil	Markov, 2 yrs	Direct medical cost and cost of caregiver time	Mild	US$73	US
Modeling study	O’Brien et al 1999	Donepezil	Markov, 5 yrs	Direct medical cost and cost of caregiver time	Mild to moderate	CA$882	Canada
Modeling study	Hauber, Gnanasakthy, Mauskopf, et al 2000	Rivastigmine	Hazard, 2 yrs	Direct medical cost and cost of caregiver time	Mild to moderate, moderate	US$2.51 per day at 1 yr; US$4.93 per day at 2 yr	Canada
Modeling study	Hauber, Gnanasakthy, Snyder, et al 2000	Rivastigmine	Cox proportional hazard model, 2 yrs	Direct medical cost of caregiver time	Mild to moderate	Mild AD: US$4289; moderate AD: US$2290	US
Modeling study	Getsios et al 2001	Galantamine	AHEAD, 10 yrs	Direct medical costs	Mild to moderate, moderate	Mild to moderate: CA$528; moderate disease: US$2533	Canada
Modeling study	Caro et al 2002	Galantamine	AHEAD, 10 yrs	Direct medical costs	Mild to moderate, moderate	US$1676	Netherlands
Modeling study	Garfield et al 2002	Galantamine	AHEAD, 10 yrs	Direct medical costs	Mild to moderate, moderate	Mild to moderate: €3131; moderate: €5594	Sweden
Modeling study	Ward et al 2003	Galantamine	AHEAD, 10 yrs	Direct medical costs	Mild to moderate	£1380	UK
Modeling study	Migliaccio-Walle et al 2003	Galantamine	AHEAD, 10 yrs	Direct medical costs	Mild to moderate	US$2408–US$3601	US
Modeling study	Jones et al 2004	Memantine	Markov, 2 yrs	Direct medical costs	Moderately severe to severe	£1,963	UK
Modeling study	Francois et al 2004	Memantine	Markov, 5 yrs	Direct medical costs	Moderately severe to severe	€1,687	Finland

Abbreviations: AD, Alzheimer’s disease; RCT, randomized controlled trials.

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