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Open Access Research article

Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer's disease in Germany using discrete event simulation

Susanne Hartz1, Denis Getsios2*, Sunning Tao3, Steve Blume4 and Grant Maclaine5

Author Affiliations

1 B214 Baquba Building, Conington Road, SE13 7FF London, UK

2 United BioSource Corporation, 430 Bedford Street, Suite 300, Lexington Office Park, Lexington, MA 02420, USA

3 United BioSource Corporation, 185 Dorval Avenue Suite 500, Dorval, Quebec H9S 5J9, Canada

4 United BioSource Corporation, 7101 Wisconsin Avenue, Bethesda, MD 20814, USA

5 Becton, Dickinson UK Limited, The Danby Building, Edmund Halley Road, Oxford Science Park, Oxford OX4 4DQ, UK

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BMC Neurology 2012, 12:2  doi:10.1186/1471-2377-12-2

Published: 8 February 2012



Previous cost-effectiveness studies of cholinesterase inhibitors have modeled Alzheimer's disease (AD) progression and treatment effects through single or global severity measures, or progression to "Full Time Care". This analysis evaluates the cost-effectiveness of donepezil versus memantine or no treatment in Germany by considering correlated changes in cognition, behavior and function.


Rates of change were modeled using trial and registry-based patient level data. A discrete event simulation projected outcomes for three identical patient groups: donepezil 10 mg, memantine 20 mg and no therapy. Patient mix, mortality and costs were developed using Germany-specific sources.


Treatment of patients with mild to moderately severe AD with donepezil compared to no treatment was associated with 0.13 QALYs gained per patient, and 0.01 QALYs gained per caregiver and resulted in average savings of €7,007 and €9,893 per patient from the healthcare system and societal perspectives, respectively. In patients with moderate to moderately-severe AD, donepezil compared to memantine resulted in QALY gains averaging 0.01 per patient, and savings averaging €1,960 and €2,825 from the healthcare system and societal perspective, respectively.

In probabilistic sensitivity analyses, donepezil dominated no treatment in most replications and memantine in over 70% of the replications. Donepezil leads to savings in 95% of replications versus memantine.


Donepezil is highly cost-effective in patients with AD in Germany, leading to improvements in health outcomes and substantial savings compared to no treatment. This holds across a variety of sensitivity analyses.