[PND25] Cost-effectiveness of memantine in the treatment of moderate to severe alzheimer’s disease in Norway

[PND25] Cost-effectiveness of memantine in the treatment of moderate to severe alzheimer’s disease in Norway

2009 Value in health

Toumi, M. | Lamure, M. | Grishchenko, M. | Cochran, J. | Rive, B. | Volume: 12, Issue: 7, Pages: A370, Memantine, Disease, Norway,

OBJECTIVES: To assess the cost-effectiveness of memantine, compared with standard
care, in moderate to severe Alzheimer’s disease (AD) patients. METHODS: A costutility
analysis was conducted based on a 3-state Markov model, which simulated 5-
year evolution of pre Full-Time-Care (FTC) patients with and without memantine
treatment in addition to any background AD therapy, in terms of time-to-FTC,
Quality-Adjusted-Life-Years (QALYs), and cost. Transition from the pre-FTC to the
FTC state was modelled using new predictive equations estimating time-to-FTC based
on clinical assessment of cognition, function, and behaviour. The equations were
derived from cohort of patients with dementia followed for four years. Treatment
effect was estimated based on the published meta-analysis of six memantine RCTs.
Both health utilities (EQ-5D) and resource utilization for the model came from a
Scandinavian Study of Cost and Quality of Life in AD. Costs were valued from the
societal perspective, and covered routine patient management, hospitalization, social
community services, institutionalisation, medications, loss in productivity, and leisure
time. Memantine cost was accounted for until patients required FTC (conservative).
Costs and benefits were discounted at an annual rate of 3%. Results were reported in
Euros (NOK), 2008. The model underwent extensive stochastic and one-way sensitivity
analyses testing the impact of model assumptions and changes in input values for
treatment effect, health utilities, cost, and discounting rates. RESULTS: Memantine
was associated with a longer time-to-FTC of 21 days, QALYs gains of 0.02 and a cost
saving of above a-900 (7,500NOK). Lower costs in memantine group were due to
prolonged pre-FTC time and offset drug acquisition cost. Memantine was costeffective
at a40,000 (300,000NOK) thresholds (72.86%). The sensitivity analyses
confirmed the robustness of the base-case scenario. CONCLUSIONS: Memantine
is associated with higher benefits for no additional costs relative to standard care,
and is a cost-effective treatment.