[PMH35] Cost-effectiveness of memantine in the treatment of moderate and severe Alzheimer’s disease patients with agitation, aggression and psychosis: the UK example

[PMH35] Cost-effectiveness of memantine in the treatment of moderate and severe Alzheimer’s disease patients with agitation, aggression and psychosis: the UK example

2010 Value in health

Rive, B. | Grishchenko, M. | Guilhaume, C. | Katona, C. | Lamure, M. | Livingston, G. | Toumi, M. | Francois, C. | Volume: 13, Issue: 7, Pages: A452, Memantine, Disease,

OBJECTIVES: To assess the cost-effectiveness of memantine in moderate and severe
AD patients who exhibit agitation/aggression and psychotic symptoms (APS) from the
UK National Health Service and Personal Social Services perspective. METHODS:
The cost-utility analysis was based on 5-year Markov cohort simulations. The model
evaluated the impact of memantine on time to Full-Time-Care (FTC), QualityAdjusted-Life-Years
(QALYs) and costs, in pre-FTC patients compared with standard
care, i.e. no pharmacotherapy or background treatment with acetylcholinesterase
inhibitors. FTC was defi ned based on locus of care and patient’s physical and functional
dependency status. Transition probabilities, baseline characteristics, resource
utilization volumes, health utility weights and mortality rates were derived from the
4.5-year London and South-East Region (LASER-AD) epidemiological study. Effectiveness
estimates came from a meta-analysis of six large randomised clinical trials.
Costs covered routine patient management, hospitalization, social community services,
institutionalization, and medications. Results were reported in EUR (GBP), 2009. The
model underwent extensive stochastic and one-way sensitivity analyses, testing the
model assumptions and changes in input parameters. RESULTS: Over fi ve years,
patients receiving standard care spend on average 78.8 weeks in the pre-FTC state.
Overall costs in this group were c117,960 (£98,810). QALYs were estimated at 1.49
(30% of full health). Memantine was associated with a longer time-to-FTC of 11.2
weeks, QALY gains of 0.07 and cost-savings of c5930 (£4970). Lower costs in the
memantine group were due to prolonged pre-FTC period. Memantine was more effective
and less costly strategy relative to standard care in 99.98% of simulations. The
estimated benefi ts and cost savings were almost twice higher than those previously
estimated in all moderate and severe AD patients, largely due to enhanced effi cacy of
memantine in APS patients, who, when left untreated, rapidly deteriorate. CONCLUSIONS:
The model showed that memantine yielded higher benefi ts at no additional
costs relative to its alternative.