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. 2019 May-Jun;41(3):218-224.
doi: 10.1590/1516-4446-2017-0021. Epub 2018 Nov 8.

Cost-effectiveness analysis of the treatment of mild and moderate Alzheimer's disease in Brazil

Luciana R da Silva  1 , Cid M M Vianna  1 , Gabriela B G Mosegui  2 , Antônio A F Peregrino  3 , Valeska Marinho  4 , Jerson Laks  4   5
Affiliations

Cost-effectiveness analysis of the treatment of mild and moderate Alzheimer's disease in Brazil

Luciana R da Silva et al. Braz J Psychiatry. 2019 May-Jun.

Abstract

Objective: To perform a cost-effectiveness analysis of donepezil and rivastigmine therapy for mild and moderate Alzheimer's disease (AD) from the perspective of the Brazilian Unified Health System.

Method: A hypothetical cohort of 1,000 individuals of both sexes, aged >65 years, and diagnosed with AD was simulated using a Markov model. The time horizon was 10 years, with 1-year cycles. A deterministic and probabilistic sensitivity analysis was performed.

Results: For mild AD, the study showed an increase in quality-adjusted life years (QALYs) of 0.61 QALY/21,907.38 Brazilian reais (BRL) for patients treated with donepezil and 0.58 QALY/BRL 24,683.33 for patients treated with rivastigmine. In the moderate AD group, QALY increases of 0.05/BRL 27,414.96 were observed for patients treated with donepezil and 0.06/BRL 34,222.96 for patients treated with rivastigmine.

Conclusions: The findings of this study contradict the standard of care for mild and moderate AD in Brazil, which is based on rivastigmine. A pharmacological treatment option based on current Brazilian clinical practice guidelines for AD suggests that rivastigmine is less cost-effective (0.39 QALY/BRL 32,685.77) than donepezil. Probabilistic analysis indicates that donepezil is the most cost-effective treatment for mild and moderate AD.

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Conflict of interest statement

VM has received grants from Novartis, Wyeth, EMS, Janssen-Cilag, Apsen Farmacê utica, Aché, Lundbeck, Lilly, moksha8, and Servier. JL has received grants from Novartis, Wyeth, EMS, Janssen-Cilag, Apsen Farmacêutica, Aché, Lundbeck, Lilly, moksha8, and Servier. The other authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Schematic representation of the disease stages of the simulation model. AD = Alzheimer’s disease.
Figure 2
Figure 2. Monte Carlo cost-effectiveness analysis of donepezil vs.rivastigmine. WTP = willingness to pay.
See this image and copyright information in PMC

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