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EVOLUTION OF A COST-UTILITY MODEL OF DONEPEZIL FOR ALZHEIMER'S DISEASE

Published online by Cambridge University Press:  20 March 2013

Jaime L. Peters ,
Rob Anderson ,
Martin Hoyle  and
Chris Hyde
Jaime L. Peters
Affiliation:
PenTAG, University of Exeter
Rob Anderson
Affiliation:
PenTAG, University of Exeter
Martin Hoyle
Affiliation:
PenTAG, University of Exeter
Chris Hyde
Affiliation:
PenTAG, University of Exeter
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Abstract

Objectives: The aim of this study was to describe the evolution of a cost-utility model used to inform the UK National Institute for Health and Clinical Excellence's (NICE) most recent decisions on the cost-utility of drug treatments for Alzheimer's disease (AD), and to explore the impact of structural assumptions on the cost-utility results.

Methods: Changes informed by noted limitations of the decision model used in NICE's previous decisions (in 2006) were made cumulatively to the original decision model for donepezil compared with best supportive care (for patients with mild to moderate AD). Deterministic and probabilistic analyses were undertaken for each cumulative change of the model. The expected value of perfect information (EVPI) of parameter estimates and structural assumptions was also calculated.

Results: Cumulative changes to the decision model highlighted how the results of the original model (incremental cost-effectiveness ratio of £81,000 per quality-adjusted life-year gained) related to those of the new model (where donepezil was estimated to be cost-saving), mainly due to uncertainty in the incremental cost of donepezil treatment over best supportive care (ranging from -£600 to £3,000 per patient). The partial EVPI analysis reflected this finding where further information on treatment discontinuations and cost parameter estimates were shown to be valuable in terms of reducing decision uncertainty.

Conclusions: Assessing the evolution of the cost-utility model helped to identify and explore structural differences between cohort-based models and is likely to be useful for decision models in other disease areas. This approach makes the structural uncertainty explicit, forcing decision makers to address structural uncertainty in addition to parameter uncertainty.

Keywords

Alzheimer's diseaseCost effectivenessDecision modelingUncertainty
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 2 , April 2013 , pp. 147 - 154
Copyright
Copyright © Cambridge University Press 2013

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References

REFERENCES

1.Wolfson, C, Moride, Y, Perrault, A.Drug treatments for Alzheimer's disease. II: A review of outcome measures in clinical trials. Ottawa: Canadian Coordinating Office for Health Technology Assessment; 2000.Google Scholar
2.Bond, M, Rogers, G, Peters, J, et al.The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of TA111): A systematic review and economic model. Health Technol Assess 2012;16:1–470.CrossRefGoogle Scholar
3.Loveman, E, Green, C, Kirby, J, et al.The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technol Assess. 2006;10:iii–iv.CrossRefGoogle ScholarPubMed
4.National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Health and Clinical Excellence; 2008.Google Scholar
5.Green, C, Picot, J, Loveman, E, et al.Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderate severe Alzheimer's disease. Pharmacoeconomics. 2005;23:1271–1282.CrossRefGoogle Scholar
6.Caro, JJ, Getsios, D, Migliaccio-Walle, K, et al.Assessment of health economics in Alzehimer's disease (AHEAD) based on need for full-time care. Neurology. 2001;57:964–971.CrossRefGoogle Scholar
7.Stern, Y, Tang, MX, Albert, MS, et al.Predicting time to nursing home care and death in individuals with Alzheimer's disease. JAMA. 1997;277:806–812.CrossRefGoogle Scholar
8.Stern, Y, Albert, SM, Sano, M, et al.Assessing patient dependence in Alzheimer's disease. J Gerontol. 1994;49:216–222.CrossRefGoogle ScholarPubMed
9.Getsios, D, Migliaccio-Walle, K, Caro, JJ.NICE cost-effectiveness appraisal of cholinesterase inhibitors: Was the right question posed? Were the best tools used? Pharmacoeconomics. 2007;25:997–1006.CrossRefGoogle ScholarPubMed
10.Longworth, L, Wailoo, A. Donepezil, rivastigmine, galantamine and memantine for the treatment of Alzheimer's disease: A review of comments submitted by consultees on the reliability of economic model. Report by the Decision Support Unit. University of Sheffield: School of Health and Related Research; 2009.Google Scholar
11.Bosanquet, N, Yeates, A.Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer's disease. Pharmacoeconomics. 2006;24:623–625.CrossRefGoogle ScholarPubMed
12.National Institute for Health and Clinical Excellence. Alzheimer's disease - donepezil, galantamine, rivastigmine (review) and memantine [TA111]. London: NICE; 2007.Google Scholar
13.Wolstenholme, J, Fenn, P, Gray, A, et al.Estimating the relationship between disease progression and cost of care in dementia. Br J Psychiatry. 2002;181:36–42.CrossRefGoogle ScholarPubMed
14.Bojke, L, Claxton, K, Sculpher, M, Palmer, S.Characterizing structural uncertainty in decision analytic models: a review and application of methods. Value Health. 2009;12:739–749.CrossRefGoogle ScholarPubMed
15.Claxton, K.Exploring uncertainty in cost-effectiveness analysis. Pharmacoeconomics. 2008;26:781–798.CrossRefGoogle ScholarPubMed
16.Claxton, K.The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J Health Econ. 1999;18:341–364.CrossRefGoogle Scholar
17.Knapp, M, Prince, M, Albanese, E, et al.Dementia UK: The full report. London: Alzheimer's Society; 2007.Google Scholar
18.Getsios, D, Blume, S, Ishak, KJ, Maclaine, GD.Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer's disease: A UK evaluation using discrete-event simulation. Pharmacoeconomics. 2010;28:411–427.CrossRefGoogle ScholarPubMed
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