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Vol. 15, No. 1, 2003
Issue release date: December 2002
Dement Geriatr Cogn Disord 2003;15:44–54

An Economic Evaluation of Donepezil in Mild to Moderate Alzheimer’s Disease: Results of a 1-Year, Double-Blind, Randomized Trial

Wimo A. · Winblad B. · Engedal K. · Soininen H. · Verhey F. · Waldemar G. · Wetterholm A.-L. · Mastey V. · Haglund A. · Zhang R. · Miceli R. · Chin W. · Subbiah P.
aDepartment of Family Medicine, Umeå University, Umeå, and bKarolinska Institutet, Huddinge, Sweden; cDepartment of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway; dDepartment of Neurology, University and University Hospital of Kuopio, Finland; eDepartment of Psychiatry, University Hospital of Maastricht, Institute of Brain and Behaviour, Maastricht, The Netherlands; fThe Neuroscience Center, Department of Neurology, Rigshospitalet, University Hospital, Copenhagen, Denmark; gPfizer AB, Taby, Sweden; hPfizer Inc., New York, N.Y., USA; iAxia Research, Toronto, Canada

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The costs and consequences of donepezil versus placebo treatment in patients with mild to moderate Alzheimer’s disease (AD) were evaluated as part of a 1-year prospective, double-blind, randomized, multinational clinical trial. Patients received either donepezil (n = 142; 5 mg/day for 28 days followed by 10 mg/day according to the clinician’s judgement) or placebo (n = 144). Unit costs were assessed in 1999 Swedish kronas (SEK) and converted to US dollars (USD). Donepezil-treated patients gained functional benefits relative to placebo on the Progressive Deterioration Scale (p = 0.042) and Instrumental Activities of Daily Living scale (p = 0.025) at week 52. Caregivers of donepezil-treated patients spent an average of 400 h less annually providing care than caregivers of placebo-treated patients. Mean annual healthcare costs were SEK 137,752 (USD 16,438) per patient for the donepezil group and SEK 135,314 (USD 16,147) in the placebo group. With the average annual cost of donepezil at SEK 10,723 (USD 1,280) per patient, the SEK 2,438 (USD 291) cost difference represented a 77% cost offset. When caregiver time and healthcare costs were included, mean annual costs were SEK 209,244 (USD 24,969) per patient in the donepezil group and SEK 218,434 (USD 26,066) in the placebo group, a total saving associated with donepezil treatment of SEK 9,190 (USD 1,097) per patient [95% CI of SEK –43,959 (USD –5,246), SEK 25,581 (USD 3,053); p = 0.6]. The positive effects on the efficacy outcome measures combined with no additional costs from a societal perspective indicate that donepezil is a cost-effective treatment, representing an improved strategy for the management of patients with AD.

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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  1. Winblad B, Wimo A: Assessing the societal impact of acetylcholinesterase inhibitor therapies. Alzheimer Dis Assoc Disord 1999;13(suppl 2):S9–S19.
  2. Meek PD, McKeithan K, Schumock GT: Economic considerations in Alzheimer’s disease. Pharmacotherapy 1998;18:68–73.
  3. Leon J, Cheng CK, Neumann PJ: Alzheimer’s disease care: Costs and potential savings. Health Aff (Millwood) 1998;17:206–216.
  4. Wimo A, Karlsson G, Sandman PO, Corder L, Winblad B: Cost of illness due to dementia in Sweden. Int J Geriatr Psychiatry 1997;12:857–861.
  5. Luce BR, Manning WG, Siegel JE, Lipscomb J: Estimating costs in cost-effectiveness analysis; in Gold MR, Siegel JE, Russell LB, Weinstein MC (eds): Cost-Effectiveness in Health and Medicine. New York, Oxford University Press, 1996, pp 178–181.
  6. Hay JW, Sano M, Whitehouse PJ: The costs and social burdens of Alzheimer disease: What can and should be done? Alzheimer Dis Assoc Disord 1997;11:181–183.
  7. Gutterman EM, Markowitz JS, Lewis B, Fillit H: Cost of Alzheimer’s disease related dementia in managed-medicare. J Am Geriatr Soc 1999;47:1065–1071.
  8. Souêtre E, Thwaites RMA, Yeardley HL: Economic impact of Alzheimer’s disease in the United Kingdom. Cost of care and disease severity for non-institutionalised patients with Alzheimer’s disease. Br J Psychiatry 1999;174:51–55.
  9. Rogers SL, Farlow MR, Doody RS, Mohs R, Friedhoff LT: A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer’s disease. Neurology 1998;50:136–145.
  10. Rogers SL, Doody RS, Mohs RC, Friedhoff LT: Donepezil improves cognition and global function in Alzheimer’s disease: A 15-week, double-blind, placebo-controlled study. Arch Intern Med 1998;158:1021–1031.
  11. Burns A, Rossor M, Hecker J, Gauthier S, Petit H, Moller HJ, Rogers SL, Friedhoff LT: The effects of donepezil in Alzheimer’s disease – Results from a multinational trial. Dement Geriatr Cogn Disord 1999;10:237–244.
  12. Winblad B, Engedal K, Soininen H, Verhey F, Waldemar G, Wimo A, Wetterholm AL, Zhang R, Haglund A, Subbiah P: Donepezil Nordic Study Group: A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology 2001;57:489–495. (Supplementary information such as abnormal medical history findings are contained at
  13. Mohs RC, Doody RS, Morris JL, Ieni JR, Rogers SL, Perdomo CA, Pratt RD; ‘312’ Study Group: A 1-year placebo-controlled preservation of function survival study of donepezil in AD patients. Neurology 2001;57:481–488.
  14. Feldman H, Gauthier S, Hecker J, Vellas B, Subbiah P, Whalen E, Donepezil MSAD Study Investigators Group: A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease. Neurology 2001;57:613–620.
  15. Rogers SL, Doody RS, Pratt RD, Ieni JR: Long-term efficacy and safety of donepezil in the treatment of Alzheimer’s disease: Final analysis of a US, multicenter open-label study. Eur Neuropsychopharmacol 2000;10:195–203.
  16. Kaufer DI, Cummings JL, Christine D: Effect of tacrine on behavioral symptoms in Alzheimer’s disease: An open-label study. J Geriatr Psychiatry Neurol 1996;9:1–6.
  17. Kaufer DI, Catt K, Pollock BG, Lopez OM, DeKosky ST: Donepezil in Alzheimer’s disease: Relative cognitive and neuropsychiatric responses and impact on caregiver distress. Neurology 1998;50(suppl 4):A89.
  18. Cummings JL, Donohue JA, Brooks RL: The relationship between donepezil and behavioral disturbances in patients with Alzheimer’s disease. Am J Geriatr Psychiatry 2000;8:134–140.
  19. Raskind MA: Psychopharmacology of noncognitive abnormal behaviours in Alzheimer’s disease. J Clin Psychiatry 1998;59(suppl 9):28–32.
  20. Fillit HM, Gutterman EM, Brooks RL: Impact of donepezil on caregiving burden for patients with Alzheimer’s disease. Int Psychogeriatr 2000;12:389–401.
  21. McRae T, Knopman D, Duttagupta S, Ieni J, Provenzano G: Donepezil delays time to nursing home placement in patients with Alzheimer’s disease. J Am Geriatr Soc 2001;49:S132.
  22. Small GW, Donohue JA, Brooks RL: An economic evaluation of donepezil in the treatment of Alzheimer’s disease. Clin Ther 1998;20:838–850.
  23. Lubeck DP, Mazonson PD, Bowe T: The potential impact of tacrine on expenditure for Alzheimer’s disease. Med Interface 1994;7:130–138.
  24. Wimo A, Karlsson G, Nordberg A, Winblad B: Treatment of Alzheimer’s disease with tacrine: A cost analysis model. Alzheimer Dis Assoc Disord 1997;11:191–200.
  25. Hauber AB, Gnanasakthy A, Mauskopf JA: Savings in the cost of caring for patients with Alzheimer’s disease in Canada; an analysis of treatment with rivastigmine. Clin Ther 2000;22:439–451.
  26. O’Brien B, Goeree R, Hux M, Iskedjian M, Blackhouse G, Gagnon M, Gauthier S: Economic evaluation of donepezil for the treatment of Alzheimer’s disease in Canada. J Am Geriatr Soc 1999;47:570–578.
  27. Neumann PJ, Hermann RC, Kuntz KM, Araki SS, Duff SB, Leon J, Berenbaum PA, Goldman PA, Williams LW, Weinstein MC: Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer’s disease. Neurology 1999;52:1138–1145.
  28. Jönsson L, Lindgren P, Wimo A, Jönsson B, Winblad B: The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer’s disease: A Markov model. Clin Ther 1999;21:1230–1240.
  29. Fillit H, Gutterman EM, Lewis B: Donepezil use in managed medicare: Effect on health care costs and utilization. Clin Ther 1999;21:2173–2185.
  30. Cummings J, Duttagupta S, Wade S, Goldberg G, Mosso A, Patton M, Haberman M: Cost savings associated with use of donepezil and managed care. Am J Geriatr Psychiatr 2001;9(suppl 1).
  31. Diagnostic and Statistical Manual of Mental Health Disorders, ed 4. Washington, APA, 1996.
  32. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
  33. Folstein MF, Folstein SE, McHugh PR: ‘Mini-Mental State’. A practical method for grading the cognitive stage of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  34. Gottfries CG, Bråne G, Gullberg B, Steen G: A new rating scale for dementia syndromes. Arch Gerontol Geriatr 1982;1:311–330.
  35. Bråne G, Gottfries CG, Winblad B: The Gottfries-Bråne-Steen (GBS) scale: Validity, reliability and application in anti-dementia drug trials. Dement Geriatr Cogn Disord 2001;12:1–14.
  36. Reisberg B, Ferris SH, deLeon MJ, Crook T: The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139:1136–1139.
  37. DeJong R, Osterlund OW, Roy GW: Measurement of quality-of-life changes in patients with Alzheimer’s disease. Clin Ther 1989;11:545–554.
  38. Lawton MP, Brody EM: Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–186.
  39. Lawton MP: Scales to measure competence in everyday activities. Psychopharmacol Bull 1988;24:609–614.
  40. Wimo A, Wetterholm AL, Mastey V, Winblad B: Evaluation of the healthcare resource utilization and caregiver time in anti-dementia drug trials; in Wimo A, Jönsson B, Karlsson G, Winblad B (eds): Health Economics of Dementia. Chichester, Wiley, 1998, pp 465–477.
  41. Canadian Coordinating Office for Health Technology Assessment: Guidelines for the Economic Evaluation of Pharmaceuticals, ed 2. Ottawa, CCOHTA, 1997.
  42. Briggs A: Economic evaluation and clinical trials: Size matters. BMJ 2000;321:1362–1363.

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