Donepezil economic evaluations

Economic studies should cover the full period over which the interventions could be expected to have an effect on resource use, survival and health-related quality of life. However, the economic evaluations of donepezil were based on effectiveness data from a limited number of trials, which were short in duration. This has a number of implications. First, the analysis can be limited to the effect of the drug during the period for which effectiveness data were available. In this case, it may be assumed that the treatment effect ceased after 6 months (Stewart et al, 1998). This assumption would only be valid if the donepezil were also discontinued at 6 months. If this is not the case, then the overall costs of the dmg may be underestimated and the benefits overestimated. 

The population considered in the analysis should be representative of the population to be treated. The trial and observational data used for the economic evaluations of donepezil may not meet this criterion. The trials have been criticized (Birks and Melzer,... 

Care for people with dementia is demanding of resources, while the outcomes of care are uncertain. To date, the economic analyses of care strategies have been limited to new drug therapies for people with Alzheimer s disease. Full economic evaluations to compare both the costs and consequences have only been conducted for one of these dmgs, donepezil. However, problems with the design and data used in these studies mean that they do not provide robust evidence to determine appropriate management strategies for dementia. 

Wimo A, Winblad B, Engedal K, et al. An economic evaluation of donepezil in mild to moderate Alzheimer s disease results of a 1 year double blind randomized trial. Dement Geriatr Cogn Disord 2003 15 44-54. 

Economic data in AD are increasing, and several studies have evaluated the cost benefits of medications. The Assessment of Health Economics in Alzheimer s Disease trial projected health and economic outcomes of AD patients treated with galantamine in the Netherlands over a 10-year period. Full-time patient care was predicted to be delayed by 10% in AD patients treated with galantamine. Studies with donepezil and rivastigmine have also predicted decreases in total costs of therapy and delayed nursing home placement. " ... 

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