Abstract
The National Institute for Health and Clinical Excellence (NICE) provisional decision against memantine and other medications for Alzheimer’s disease (AD) has generated much discussion. In its decision, NICE expressed concern about the data source used for the utility scores in the industry submission of the memantine model. NICE therefore turned to an alternative data source. However, in doing so, it made the key assumption that moderate-to-severe AD patients living in the community were independent. Furthermore, the NICE data source also had its limitations.
There are numerous limitations in inferring from available data how utilities vary between dependent and non-dependent patients with AD. Most importantly, we lack direct evidence from primary data. Nonetheless, it seems reasonable to assume that patients with severe AD, and likely those with moderate AD as well, have full-time care needs, regardless of their setting. The NICE assumption that they do not results in a difference in utilities between dependent and nondependent AD individuals of only 0.06. This seems to be at the low end of what one would consider a reasonable estimate.
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References
National Institute for Clinical Excellence. Appraisal Consultation Document: donepezil, rivastigmine, galantamine, and memantine for the treatment of Alzheimer’s disease (online). Available from URL: http://www.nice.org.uk/page.aspx?o=245909 [Accessed 2005 Jun 1]
AD2000 Group. Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomised double-blind trial. Lancet 2004; 363: 2105–15
Andersen CK, Wittrup-Jensen KU, Lolk A, et al. Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia. Health Qual Life Outcomes 2004; 2: 52
Neumann PJ, Hermann RC, Weinstein MC. Measuring QALYs in dementia. In: Wimo A, Jonsson B, Karlsson G, et al., editors. Health Economics of Dementia. Sussex: John Wiley & Sons, Ltd, 1998: 359–70
Neumann PJ, Kuntz KM, Leon J, et al. Health utilities in Alzheimer’s disease: a cross-sectional study of patients and caregivers. Med Care 1999; 37: 27–32
Neumann PJ, Sandberg EA, Araki SS, et al. A comparison of HUI2 and HUI3 utility scores in Alzheimer’s disease. Med Decis Making 2000; 20: 413–22
Ward A, Caro JJ, Getsios D, et al. Assessment of health economics in Alzheimer’s disease (AHEAD): treatment with galantamine in the UK. Int J Geriatr Psychiatry 2003; 18: 740–7
Livingston G, Katona C, Roch B, et al. A dependency model for patients with Alzheimer’s disease: its validation and relationship to the costs of care: the LASER-AD Study. Curr Med Res Opin 2004 Jul; 20 (7): 1007–16
Sapin C, Livingston G, Katona C, et al. Main factors influencing preference-based utility values in Alzheimer’s disease: results from the LASER-AD study presentation. 7th International Conference on Alzheimer’s and Parkinson’s Disease; 2005 Mar 9–13; Sorrento, Italy
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The author has served as a consultant to H. Lundbeck A/S, and support was provided by H. Lundbeck A/S for the preparation of this manuscript. The author drafted the entire manuscript himself and the views expressed are his.
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Neumann, P.J. Health utilities in Alzheimer’s disease and implications for cost-effectiveness analysis. Pharmacoeconomics 23, 537–541 (2005). https://doi.org/10.2165/00019053-200523060-00002
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DOI: https://doi.org/10.2165/00019053-200523060-00002