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Pharmacotherapy for people with Alzheimer's disease: a Markov‐cycle evaluation of five years' therapy using donepezil
Author(s) -
Stewart Alan,
Phillips Richard,
Dempsey Graham
Publication year - 1998
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/(sici)1099-1166(199807)13:7<445::aid-gps794>3.0.co;2-e
Subject(s) - donepezil , pharmacotherapy , dementia , placebo , medicine , clinical trial , indirect costs , alzheimer's disease , disease , gerontology , alternative medicine , accounting , pathology , business
This article combines data from a clinical trial of donepezil with costing figures to evaluate expected direct costs of care over 5 years after diagnosis of Alzheimer's disease (AD) for patients aged 75 years and over at diagnosis. A Markov model simulates the progression of elderly persons through changing levels of severity. The model compares three treatment regimes for each of two patient groups: mild AD at start of treatment; moderate AD at start of treatment. Patients are followed until 5 years after the start of the treatment. Despite the acquisition costs, use of donepezil is approximately cost‐neutral for both 5 mg and 10 mg treatment groups and for patients initially at either mild or moderate states of illness. Expected costs are slightly higher than for the placebo group, but higher expenditure on drugs is partly offset by lower costs of care consequent on treated patients not declining as rapidly as those untreated. The model showed that donepezil patients spent less time in the state of severe dementia, where costs of care are higher. Sensitivity analysis on key assumptions demonstrated that expected costs were highly dependent on discount rate and, more significantly, on the mortality rate. © 1998 John Wiley & Sons, Ltd.