OBJECTIVES

: Alzheimer’s disease (AD) is a chronic and irreversible syndrome, which is common among the elderly. As AD is a progressive neurodegenerative disease, and current recommended treatments only alleviate AD symptoms, the burden has become a growing issue within an aging population. The tricyclic antidepressant, trazodone, has been suggested to have an effect on the treatment of mild-stage, late-onset AD.

METHODS

: A decision model-based economic evaluation was conducted to identify the potential cost-effectiveness of trazadone against best standard of supportive care (natural history of progression, BSC) in patients with mild-stage, late-onset AD from the English NHS and social care perspective. Patients were 65-years of age at the start of the model and had a diagnosis of mild-stage, late-onset AD. The efficacy of trazadone was estimated from clinical judgement based on a pre-clinical study in mouse models. Patients transitioned between different health states (e.g. mild, moderate, severe, or dead) for each year of life expectancy (1-30) based on their Mini Mental State Examination (MMSE; cognitive measure) score. Health benefit was measured using quality-adjusted life-years (QALYs).

RESULTS

: The results showed trazodone was the most cost-effective strategy (ICER: £17,737; INMB: £11,978) in comparison to BSC in patients with mild-stage late-onset AD, at a £20,000 threshold (societal perspective), with 85% confidence over 1000 simulations.

CONCLUSIONS

: The results suggest that trazodone is the most cost-effective strategy for treating mild-stage late-onset AD. A sensitivity analysis indicates that improvements in utility (patient and carer) are sufficient to justify a higher cost from repurposing trazodone, and that further research to decrease uncertainty would be of value. Therefore, while further research is required to test the efficacy of trazodone in neurodegeneration in humans before trazodone is used, it is important not to underestimate the significant savings repurposing have on time and money by skipping phase one clinical trials.