Pharmacoeconomics of Alzheimer's disease

BACKGROUND - Alzheimer's disease (AD) is the most common form of dementia, comprising an estimated 60 to 80% of the dementing illnesses. As a result of increasing life expectancy and the rising incidence of dementia with advancing age, dementia is a major public health concern. The costs of treatment for AD in the United States rank it among major diseases, but its true costs are not well understood. Pharmacological treatment for AD has been available only in the past 7 years, and much needs to be learned about the current and potential benefits of AD treatment. REVIEW SUMMARY - The costs of caring for patients with AD can be divided into two categories: informal and formal. Informal care is largely provided by family caregivers. The costs associated with informal care involve the time spent in caregiving that constitutes lost opportunities for paid employment. Formal care includes acute medical services as well as day care, respite care, and especially long-term care. These generate what are referred to as formal costs, which are definitely higher for patients with AD than for other comparably aged patients. The introduction of cholinesterase inhibitors to treat AD has raised questions about their economic costs and benefits. Although virtually all clinical trials of anti-AD drugs are of short duration, economic modeling has made it possible to gain some insight into the economic benefits of anti- AD drugs over a longer time period. Four studies that describe economic costs and benefits of anti-AD therapy are reviewed. Because of the uncertainty about the duration and size of clinical effects of cholinesterase inhibitors, the estimates of costs and benefits span a range from cost-saving to expensive. Varying estimates also arise for the impact of anti-AD drugs on formal versus informal costs. If anti-AD therapies were to be shown to reduce formal costs such as nursing home placement, the impact of pharmacological intervention in AD could be dramatic. Economic modeling shows, however, that anti-AD drugs need to reduce informal costs to achieve more sizable economic impact. CONCLUSIONS - Given the efficacy of cholinesterase inhibitors and the current data on the duration of their effects, the estimated economic benefits of this class of drugs are modest. Developing economic models depict what order of magnitude of drug effects are necessary before substantial economic benefits could possibly occur.