Abstract

PINTO, Carlos Gouveia et al. Economic evaluation of the therapeutics and non-pharmacological suppor . Arq Med [online]. 2005, vol.19, n.5-6, pp.183-190. ISSN 2183-2447.

Introduction: The pharmacological therapy of Alzheimer’s disease is complex and expensive justifying both a clinical and an economic evaluation. This article aims at contributing for the latter as its objectives are to calculate the incremental public and private expenditures induced by the reimbursement of donepezil and to identify the additional costs born both by patients and the State (NHS and Social Security) if reimbursement was not restricted to prescriptions of this drug by psychiatrists and neurologists. Methods: A cost-minimisation analysis was developed being length of stay in each stage of the disease (measured by the MMSE) in a five year time horizon determined through a double blind randomized clinical trial and transposed to a Markov model. Next, costs of treatment per patient and per therapeutic alternative were calculated for the same time horizon using official data. A specific model was built to estimate the access costs to visits of hospital specialists. Results: Donepezil´s reimbursement leads to an increase of 234€ increase in public expenditure and savings of 111€ in private expenditure, per patient, in five years. If the drug was reimbursed independently of doctor’s specialty, State’s expenditure would increase to 645€ while patients’ savings would amount to 521€ per patient. Conclusions: Increase in public spending is low in both scenarios. Moreover, as public expenditure is overestimated while patients’ savings are underestimated, if full effects were accounted for most probably the latter would overcome the former inducing a net social gain.

Keywords : donepezi; alzheimer's disease; cost-minimisation; economic evaluation.

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