Commentary on “Health economics and the value of therapy in Alzheimer's disease.” Cost-effectiveness studies

The high prevalence of dementia has a great impact on the formal care systems as well as on the situation for informal caregivers. Thus the question of cost effectiveness is crucial. This paper is based on the health-economic portion of the dementia project of the Swedish Council on Technology Assessment in Healthcare. After a database search and quality judgment of papers, 35 papers were included (22 were pharmacoeconomic studies, and 13 focused on programs, such as daycare, caregiver support, and living arrangements). No empirical drug study was regarded as a complete health-economic study. Of the four prospective, randomized, controlled trials, three yielded a nonsignificant difference regarding costs (all for donepezil), whereas there was a significant cost reduction in the Memantine study (favoring Memantine treatment), mainly due to reduction in caregiver time. The majority of the complete pharmacoeconomic modeling studies showed a dominance for drug treatment, indicating cost effectiveness. In conclusion, as regards the cost effectiveness of treatment for Alzheimer's disease, no evidence could be stated in terms of empirical studies, mainly because of a lack of studies. Although most models indicated cost effectiveness, the Swedish Council on Technology Assessment in Healthcare did not regard this as sufficient evidence of cost effectiveness. There is a need for larger and longer empirical studies, and for enlarged sensitivity analyses, in terms of model studies.