AChEIs and memantine cost-effective, offer improvements in AD

A systematic review and meta-analysis of Alzheimer’s disease (AD) therapies’ cost-effectiveness carried out by researchers from The Chinese University of Hong Kong (CUHK) identifies acetylcholinesterase inhibitors (AChEIs) and memantine as cost-effective and offering improvements in dementia-related symptoms.

In an ageing society, cost-effectiveness of dementia medication is a crucial issue for physicians and policy-makers alike. “Our study aimed to provide a clearer synthesis of existing evidence by assessing the empirical evidence of the cost-effectiveness of different pharmacological interventions for AD and other dementias,” wrote the researchers.

The titles and abstracts of 10,616 studies were screened, with priority given to trial-based articles. In sum, the review included 10 studies, which evaluated any pharmacological interventions for AD or other dementias, involved a control group who received placebo, no treatment, or other alternatives, and reported the costs and subjects’ health outcomes. A total of 3,664 participants were involved, with a mean age between 70 years and 79 years. [Cost Eff Resour Alloc 2022;doi:10.1186/s12962-022-00354-3]

Drugs for AD and other dementias included in the analyses were the AChEIs, donepezil and galantamine; cholinesterase inhibitor, rivastigmine; NMDA receptor antagonist, memantine; phosphodiesterase inhibitor, propentofylline; antidepressants, mirtazapine and sertraline; and atypical antipsychotics, olanzapine, risperidone, and quetiapine.

Based on the results of meta-analysis, AChEIs increased the healthcare cost, but an inverse trend of savings in total cost was found when taking informal care into consideration. AChEIs also demonstrated significant efficacy in terms of patients’ cognition, activity functioning, global deterioration, and behavioral and psychological symptoms of dementia (p<0.001 for all).

“Subgroup analyses indicated that AChEIs were more cost-saving after considering informal care, longer usage period [≥1 year] and among older persons [mean age ≥75 years] with dementia. At the same time, they were more effective among persons with moderate-to-severe dementia,” added the researchers.

The cost-effectiveness of memantine for patients with dementia was more apparent, indicating cost savings from both healthcare and societal perspectives, as well as significant improvements in cognitive and activity functions.

The researchers noted that findings of AChEIs’ and memantine’s cost-effectiveness, associated significant improvements in patients’ dementia-related symptoms, and their nonsignificant savings in total societal cost were consistent with previous studies. [Expert Opin Pharmacother 2018;19:1245-1259; Age Ageing 2013;42:14-20]

Antipsychotics and antidepressants only showed limited improvements in patients’ neuropsychiatric symptoms. By contrast, they were associated with significant deterioration in patients’ cognition (antidepressants, p=0.048) or activity function (antipsychotics, p=0.034). The only health benefits were antidepressants’ improvements in quality-adjusted life years (QALYs) gained (p=0.049). The pooled estimates also showed that antipsychotics were associated with lower healthcare cost, while antidepressants decreased societal cost. However, these differences were not significant.

“Although antidepressants indicated higher QALYs for patients alongside neutral incremental cost, their negative impacts on patients’ cognitive functions should not be neglected. Their benefits were also limited to neuropsychiatric symptoms. Meanwhile, antipsychotics were not regarded as cost-effective due to limited benefits on healthcare cost and health outcomes, alongside significant side effects on activity functions,” commented the researchers.