Cost-Effectiveness Analysis of the Correct vs Improper Use of Rivastigmine Transdermal Patch in Patients With Alzheimer's Disease in Colombia

OBJECTIVES: Rivastigmine transdermal patch is used to treat mild to moderate Alzheimer's disease (AD). Proper administration of this patch is crucial for achieving desired therapeutic effects and minimizing adverse events. Improper use, including incorrect titration and erroneous application, can lead to suboptimal therapeutic outcomes and increased healthcare costs. This study aims to evaluate the cost associated with the improper use of the rivastigmine patch in patients with AD.

METHODS: A cost-effectiveness analysis was developed using a Markov model that included health states based on severity (mild, moderate, severe) and considered transitions between these states, mortality, institutionalization (Ins), and nutritional support requirements (NSR). Four scenarios were evaluated: no treatment, improper use (incorrect placement), treatment with a 4.5 mg/day patch(9mg) without titration, and treatment with a 13.3 mg/day patch(27mg) with proper titration. Data for the model parameters were obtained from clinical trials and published literature. Sensitivity analyses were conducted to assess the robustness of the model.

RESULTS: Over a 15-year horizon, the use of the 13.3 mg/day rivastigmine patch with proper titration was the most cost-effective intervention, with lower costs for Ins ($2,419) and NSR ($1,247) compared to no treatment (Ins $3,832 and NSR $2,508) and improper use of the patch (Ins $3,869 and NSR $1,666). The model showed that the proper use of the 13.3 mg/day rivastigmine patch resulted in better outcomes in terms of life years saved (12.425) and quality-adjusted life years (1.582). The incremental cost-effectiveness ratio (ICER) for the 13.3 mg/day demonstrating its dominant against without titration and improper use.

CONCLUSIONS: Proper titration and administration of the 13.3 mg/day Exelon patch is cost-effective for treating AD patients, resulting in significant health benefits and cost savings. Improper use leads to substantial additional costs and reduced effectiveness, emphasizing the importance of correct patch usage.