OBJECTIVES: The cost-effectiveness of anti-dementia products is often debated. The aim of the study was to analyse the prescribing of these products in a private healthcare setting to determine the impact of the introduction of generic equivalents on prescribing patterns.

METHODS: A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2018. The database contained 4191138 records for medicine, medical devices and procedures. All products in ATC group N06D were analysed.

RESULTS: Forty-nine patients received one or more anti-dementia prescriptions during the year. The average age of patients was 68.65 (SD=17.79) years (55.10% females). Most prescriptions were for memantine 10 mg tablets (N06DX01, 54.47%), followed by donepezil 5 mg and 10 mg tablets (N06DA02, 45.53%). Galantamine and rivastigmine were not prescribed. Patients received on average 7.08 (SD=6.60) prescriptions during the year. For both active ingredients, the originator product and four branded generics were prescribed. There was a general decrease in the number of prescriptions per month towards the end of the year as expected, since the medical insurance benefits of patients often get depleted towards the end of the year. Only 38.82% of the claimed amounts were paid by the medical aids. There was a clear decline in the prescribing of the more expensive originator products towards the end of the year. Similar to previous South African studies, a low percentage of patients were on a combination of anti-dementia active ingredients. Only five of the 49 patients received prescriptions for both memantine and donepezil during the year.

CONCLUSIONS: The introduction of generic equivalents have made anti-dementia products more affordable. Current evidence suggests that treatment decisions in dementia should be based on assessment of benefit in individual patients rather than broader societal or economic factors, and this should be investigated in further studies.