OBJECTIVES : Currently, Alzheimer’s disease (AD) has no cure. Pharmacological treatment involves symptomatic improvement of cognition using acetylcholinesterase inhibitor (AChEI) and memantine. Most health care costs associated with AD occur during the more severe stages of the disease. The cost effectiveness of current medications will guide decision makers in making judicious use of scarce healthcare resources, particularly during the advanced disease stages. We aim to assess the cost-effectiveness of memantine/AChEI combination compared with best supportive care, AChEI monotherapies, and memantine monotherapy in patients with moderate-to-severe Alzheimer’s disease.

METHODS : This pharmacoeconomic evaluation study used a state-transition Markov cohort model to simulate the costs and effectiveness of memantine/AChEI combination compared with monotherapies of AChEI and memantine in patients aged 65-74 years with moderate-to-severe AD over a 20-year time horizon with a 1-year cycle length from a US healthcare and societal perspective. We calculated quality-adjusted life-years (QALYs), costs (in 2018 $US), net monetary benefits, and incremental cost-effectiveness ratios (ICERs).

RESULTS : This cost-effectiveness analysis suggests that rivastigmine transdermal patch is the optimal treatment strategy at a willingness-to-pay (WTP) threshold of $150,000/QALY from both health care (ICER = $74,802/QALY [vs. donepezil/memantine]) and societal (ICER = -$66,359/QALY [vs. donepezil/memantine]) perspectives. Results across subgroups also suggests that rivastigmine transdermal patch is the optimal treatment strategy with the highest NMB and WTP value below the $150,000/QALY for both healthcare and societal perspectives.

CONCLUSIONS : From the US healthcare and societal perspectives, we found that, for moderate-to-severe AD patients aged 65-74 at a WTP value of $150,000, the rivastigmine transdermal patch is the cost-effective treatment. Given that the transdermal patch is a preferred route of administration for AD patients and caregivers due to its convenience, our findings provide additional incentive for its use. These finding are consistent across subgroups by age and gender. Future studies may explore the cost-effectiveness of these agents other age groups.