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

• Published in: Revista brasileira de psiquiatria 2019-05, Vol.41 (3), p.218-224
• Main Authors: da Silva, Luciana R, Vianna, Cid M M, Mosegui, Gabriela B G, Peregrino, Antônio A F, Marinho, Valeska, Laks, Jerson
• Format: Article
• Language: English
• Subjects: administration; Aged; Alzheimer Disease - diagnosis; Alzheimer Disease - drug therapy; Alzheimer Disease - economics; Alzheimer’s disease; Brazil; Cholinesterase Inhibitors - economics; Cholinesterase Inhibitors - therapeutic use; Cohort Studies; Cost-Benefit Analysis; Donepezil - economics; Donepezil - therapeutic use; economic issues; Female; geriatric psychiatry; Humans; Male; National Health Programs; Original; PSYCHIATRY; Quality-Adjusted Life Years; Rivastigmine - economics; Rivastigmine - therapeutic use; Treatment Outcome
• ISSN: 1516-4446; 1809-452X; 1809-452X
• DOI: 10.1590/1516-4446-2017-0021

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. 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. 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. 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.