Economic considerations in the treatment and management of Alzheimer's disease.

Abstract

Cost issues and formal economic evaluations of treatment for Alzheimer's disease (AD) are reviewed. The annual cost of AD in the United States is estimated to be $100 billion. Each case of AD is associated with total costs of up to $195,000, with a substantial portion of this attributable to lost patient and caregiver productivity and to family out-of-pocket expenses. Only a few studies have evaluated the economic impact of therapeutic interventions in AD. In one study of tacrine, dosages greater than 80 mg/day significantly delayed nursing-home placement. In another study, treatment that improved cognitive deficits significantly reduced the time spent by caregivers, an outcome that is also associated with reduced indirect costs. A decision-analytic model that incorporated the progressive nature of AD demonstrated an average cost saving of $9250 for each patient started on tacrine at the time of diagnosis. This saving was attributed to the delay in nursing-home placement. Other studies have described a mathematical model that considers the relationship between cognitive performance and the cost of illness; it can be used to obtain an initial estimate of the economic benefit of new AD treatments. The available economic studies indicate that, when used appropriately, cholinesterase inhibitors improve outcomes and reduce costs for patients with mild to moderate AD.