Rational choice of cholinesterase inhibitor for the treatment of Alzheimer's disease in Canada: a comparative economic analysis

Jaime Caro¹^,2 , Denis Getsios³ , Kristen Migliaccio-Walle¹ , Jack Ishak⁴ and Wissam El-Hadi⁴ for for the AHEAD Study Group

¹Caro Research Institute, Concord, MA 01742, USA

²Division of General Internal Medicine, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada

³Caro Research Institute, Hammonds Plains, Nova Scotia, B4B 1N6, Canada

⁴Caro Research Institute, Dorval, Quebec, H9S 5J9, Canada

author email corresponding author email

BMC Geriatrics 2003, 3:6doi:10.1186/1471-2318-3-6


Published:	15 December 2003

Abstract

Background

Cholinesterase inhibitors, such as galantamine, donepezil and rivastigmine are approved for symptomatic treatment of Alzheimer's Disease (AD) in Canada. In making choices amongst these drugs, one should consider their clinical merits and their economic implications.

Methods

Each drug's short-term efficacy was estimated based on independent Cochrane reviews of the clinical trials. Long-term clinical and economic outcomes were estimated using the Assessment of Health Economics in Alzheimer's Disease (AHEAD) model.

Results

While all treatments reduced the need for full-time care, only galantamine and donepezil 10 mg reduced the overall management costs of AD patients. The somewhat greater cognitive effect provided over six months by galantamine leads to the longest estimated delay before full-time care is required and, consequently to lower overall costs, with savings estimated at between $323 and $4,246.

Conclusion

Although there is uncertainty in estimated results, the best information currently available suggests that the first choice for treatment of AD should be galantamine. These results should be interpreted with caution, however, as results are not based on direct comparisons among the drugs and the differences emerging from meta-analyses of the trials are relatively small.