OBJECTIVES: A growing area of research has investigated the outcomes of donepezil and physical exercise activities in human beings with Alzheimer`s disease (AD) and Mild Cognitive Impairment (MCI). AD is characterized by excessive cognitive impairments which might be related to deposition of amyloid plaques(Aβ). MCI is the degree among the predicted decline in reminiscence and questioning that occurs with age and can later progress into dementia. Our aim in this study was to develop a cost effectiveness analysis (CEA) of physical exercise as opposed to donepezil for the control of AD and MCI.

METHODS: A partitioned survival model was developed to assess the cost-effectiveness of donepezil versus exercise. Cost of physical exercise was obtained from Medicare physical exercise Advantage Plans’ average price, and for donepezil, the average retail price within the US was used. The model was developed from a US payer perspective and was envisioned for a time horizon of one-year. Outcome/Effectiveness was represented via way of means of Effect size (g) values that have been acquired from a scientific overview and meta-evaluation posted article. MMSE scale turned into the evaluation device for AD and the ADAS scale turned into the device for MCI.

RESULTS: In the base case analysis, exercise was more expensive than donepezil ($420 vs $384) but yielded an improved benefit of MMSE (0.46 vs 0.23) with an incremental cost effectiveness ratio (ICER) of $159 for AD patients. As for the MCI patients, donepezil showed an improved benefit of ADAS (-0.13 vs -0.21) over exercise and had an ICER of $459. The probabilistic sensitivity analysis showed an ICER of $162 for MMSE/AD and $480 for ADAS/MCI.

CONCLUSIONS: In AD patients, exercise was confirmed to have an incremental benefit of 0.225 as compared to donepezil; however, in MCI patients, donepezil confirmed incremental benefit of 0.078g as compared to exercise.