The economic impact of the tacrine in the treatment of Alzheimer's disease.

Alzheimer's disease is a progressive neurodegenerative disorder that results in tremendous economic and quality-of-life burdens. This paper presents estimates of the impact of tacrine use on the costs of caring for patients with Alzheimer's disease. This study presents a cost analysis, based on a decision-analytic model constructed around the milestones in the progression of Alzheimer's disease. Clinical data concerning the effectiveness of tacrine came from published results of an open-label follow-up study of 663 patients originally enrolled in a placebo-controlled clinical trial of tacrine. Data concerning longevity, nursing home time, and costs of community and nursing home care are taken from several reports based on prospective cohorts of patients. The use of tacrine was associated with a cost savings of $9,250 (7.5%) over the patient's lifetime from diagnosis to death, even when averaged over data from patients who discontinued tacrine treatment or took only low doses. Most of the savings were due to reduced time in nursing homes. Patients who continued higher doses of tacrine experienced a cost saving of more than $36,500 over 5 years. Model results persisted over a wide range of sensitivity analysis variations. The use of tacrine for patients with mild-to-moderate Alzheimer's disease reduces the costs of medical and social services required for care, and it increases functioning and delays nursing home placement for up to 433 days. New treatments that can both improve clinical outcomes and save costs should be given serious consideration by clinicians and administrators.

Pharmacoeconomics of dementia.

Pharmacoeconomics is a new discipline with its own terminology and techniques, little known to most clinicians but destined to become more important to them and to their patients. This article reviews basic approaches in pharmacoeconomics; current knowledge of costs related to dementia; assessment of quality of life in patients with cognitive impairment; models of relationships among degree of cognitive impairment, caregiver burden, and health care utilization; existing pharmacoeconomic guidelines for drug studies; pharmacoeconomic studies of tacrine, a drug used in Alzheimer disease; and further work needed to advance the critical area of pharmacoeconomic studies in dementia.

[Therapeutic results: tacrine]. / Actualité thérapeutique: la tacrine.

Tacrine is the first drug having been demonstrated as effective for the treatment of mild and moderate forms of Alzheimer's disease. It works as a potent centrally active inhibitor of acetylcholinesterase and therefore has cholinomimetic properties. The authors evaluate the costs/benefits ratio of this drug taking into account clinical and economical data.

Treatment of Alzheimer disease with tacrine: a cost-analysis model.

In a cost-analysis model, the effect on the costs of Alzheimer disease of tacrine (tetrahydroaminoacridine) treatment was studied. A model of the survival of the Swedish Alzheimer disease population was constructed in which the placement of patients with Alzheimer disease in care organization was assumed to be influenced by the use of tacrine. Based on this model, the cost analysis was performed. Fifty-two percent of the Alzheimer disease population with an initial Mini-Mental State Examination (MMSE) score of 10 to 24 points are in the main alternative of the model treated with 160 mg tacrine with an initial improvement in MMSE of 2.6 points. The benefit of tacrine was a cost reduction of 1.3% when the results were calculated for the entire Alzheimer disease population. This corresponds to a benefit of 1.3 billion Swedish kronor (SEK) (with 3% discount rate) for the entire estimated survival period. The annual benefit per patient was estimated as 2,900 SEK [approximately U.S. $320 (1993)]. In the sensitivity analysis, the range was between -0.6% and 5.2%. Beginning treatment in the early stages of Alzheimer disease results in lower costs than a later start. The main conclusion is that tacrine, according to the model, has beneficial but modest effects on the costs of Alzheimer disease in Sweden.

The impact of new pharmaceutical agents on the cost of neurologic care.

Since the emergence of the specialty, neurologists have worked with a rather restricted list of relatively inexpensive pharmacologic agents. This is rapidly changing with the development of new agents for the treatment of migraine, multiple sclerosis, Parkinson's disease, Alzheimer's disease, and epilepsy, accelerated in part by designation of the 1990s as the "Decade of the Brain." Exciting as these developments are, they are very costly when applied to the large number of patients who may benefit, perhaps exceeding $6.4 billion. Since this cost exceeds the $1.5 billion income of all practicing neurologists, it enhances the value of the neurologic consultation, which can provide more accurate diagnosis and more expertly directed therapy. Our relationships with the drug manufacturers are changing as our prescribing habits become a more likely determinant of profits.

Potential effect of tacrine on expenditures for Alzheimer's disease.

Tacrine is the first drug approved for the treatment of mild or moderate Alzheimer's disease (AD). The present study evaluates the potential ramifications of tacrine on AD costs. An economic model was specified to link cognitive changes observed in a 30-week clinical trial of tacrine with estimates of the cost of AD, drug therapy, monitoring, time in a nursing home, and survival from diagnosis. Two groups were evaluated: (1) 367 patients receiving varying doses of tacrine, including treatment failures, and (2) 67 patients able to tolerate the high dose of 160 mg/day. Based on a literature review, a patient with AD survives a mean 4.4 years from diagnosis and incurs lifetime treatment costs of $57,169 (1993 dollars). Patients taking doses of 80-160 mg/day, showed an improvement in Mini-Mental State Exam (MMSE) of 1.0 point, which resulted in 9.5 months of predicted community and institutional care avoided, for annual savings of $2,243/patient (range, $-109 to $3,342). Patients able to tolerate the 160-mg dose improved 2.0 points on the MMSE, resulting in a prediction of 12.1 months of reduced community and nursing home care, for annual savings of $4,052/patient. Tacrine therapy could generate savings up to 17% of the current costs of AD, or a total of $3.6 billion annually for the estimated 1.6 million persons with mild-to-moderate AD.