Presently 42 % of our population in the UK is affected by dementedness. Almost 80 % of Alzheimer ‘s disease may affect dementedness. In a population of 500,000 people, the prevalence of Alzheimer disease is around 3330 people, this equates to 0.6 % of the population ( 1 ) . The national institute of clinical counsel has recommended Donepezil for the intervention of mild to chair Alzheimer ‘s disease. The Nice[ 1 ]ordering guidelines have been based on legion clinical tests that have shown Donepezil to be effectual in keeping both cognitive and planetary map for up to one twelvemonth before there is subsequent gradual impairment. Hence the intervention involves reconstructing cholinergic map, to detain the advancement of cognitive damage.
There were 11 economic ratings of Donepezil made, three of which were related to economic ratings in the UK. All of these surveies have concluded with different consequences. 5 of the 11 surveies showed Donepezil to be cost effectual ( 1 ) . One of the surveies related to the UK showed that based merely on the costs of the drugs, the “ estimated cost per quality adjusted life twelvemonth gained for 5mg/day was ?21,000 for a two twelvemonth theoretical account, an mean addition of 0.08 QALY ‘s per individual ” . On the other manus Surveies on cost effectivity by SHTAC[ 2 ]suggest that Donepezil intervention has a “ cost per QALY in surplus of ?80, 000 and the incremental additions are little over 5 old ages ” ( 2 ) . However at the same clip they have said that handling a patient with Donepezil does cut down their clip spent in “ full clip Care by 1.42 -1.59 months ” .
Despite the differences in the surveies, all have agreed that the costs involved in caring for patients with terrible Alzheimer ‘s disease are much higher. The increased costs are associated with institutional attention such as nursing and residential places. The premise is that the cost of attention is related to the degree of cognitive ability, later patients with lower MMSE[ 3 ]tonss will incur greater costs ( 2 ) . Hence costs can be saved by detaining the patterned advance of the disease to a more terrible province. The premise although can non be considered wholly right because the ability of a patient to execute day-to-day activities can besides act upon whether they require institutional attention. In add-on economic ratings besides assume that everyone given the intervention will go on the intervention, and do non take into history patients who discontinue the intervention when ciphering cost effectivity.
Two of the longest continuance tests showed that Donepezil given at 5mg/day or 10mg/day improved the clinical end points, i.e. slowed the diagnostic patterned advance of the disease. Randomised non-blind clinical tests in the USA have shown that Donepezil is able to keep cognitive, planetary map and “ activities of day-to-day life for up to 81 hebdomads ” . ( 3 ) After 81 hebdomads disease patterned advance starts to happen, but it occurs at a much slower rate than in an untreated patient. Datas from these tests besides suggest that the quality of life of patients is improved in patients with mild to chair Alzheimer ‘s disease who are given 5mg/day of Donepezil as opposed to 10mg/day due to the reduced inauspicious affects experienced ( 3 ) .
In order to find, and asses the cost-effectiveness of a drug, it is of import to cognize whether the drug has clinical benefits on patient ‘s quality of life. Although clinical informations suggests there is a definite clinical benefit in detaining patterned advance of disease in the short term, the fact there is no conclusive informations measuring the clinical benefit of the drug in the long-run, makes it hard to measure whether the drug will be cost-efficient. One thing is definite that it is better to order patients enduring from dementedness induced by mild to chair Alzheimer ‘s disease with the lower doses of the drug, as the higher dosage is associated with more inauspicious effects, taking to many patients stoping the drug. Administering a lower dosage therefore would be far more cost-efficient because it is less expensive, and there is more opportunity of patients taking it and optimizing usage of the drug.
Patients with mild dementednesss are able to get by without any aid, but as the disease progresses they all require the assistance of carers, more than half demand residential attention. This is usually termed as end point of the disease. Presently the entire cost of attention for people who have dementia has been estimated to be ?6 billion per twelvemonth in the UK. Donepezil costs ?63.54 for 28 tablets of 5mg and ?89.06 for 28 tablets of 10mg ( 2 ) . This consequences to ?828.29 and ?1160.96 per twelvemonth per patient. In a population of 500,000, if 3330 people suffer from Alzheimer ‘s ( 1 ) , the cost of the 5mg drug per twelvemonth per patient will compare to ?27582054.67 ( presuming all patients are enduring from mild to chair alzheimer ‘s disease ) . Consequently the cost of full clip attention per twelvemonth equates in surplus of ?27000 per dementedness patient ( 2 ) . Full clip attention involves NHS cost and societal attention costs.
From the clinical informations above it is apparent that the usage of Donepezil in people with dementedness at an early phase, can assist detain patterned advance of the disease from mild to severe and detain the demand for carers and institutionalisation. Presently the other drugs available Rivastigmine and Galantamine are besides prescribed by NICE for intervention of mild to chair Alzheimer ‘s disease, nevertheless clinical informations shows that of the three drugs, Donepezil is most tolerated. Therefore I believe that the drug would be cost-saving because it would assist cut down the costs that would otherwise be incurred due to full clip attention. Patients would necessitate care-givers at a much later phase in their lives and for a shorter period therefore diminishing both indirect and direct costs. It is besides of import to observe that many patients are being cared for by unpaid carers ( such as household and friends ) , therefore doing the drug even more cost-efficient. Donepezil will besides assist decrease the care-giver load. I understand that the current clinical information has merely suggested benefits in people with dementedness associated with Alzheimer ‘s disease, and hence would non urge the usage of the drug in any other signifier of dementedness. I besides believe that the drug should merely be prescribed for patients with mild to chair province of Alzheimer ‘s disease, as clinical informations has non shown clear benefits in patients with more terrible provinces. Although there is no clinical grounds presently on the long-run consequence of the drug, I feel that the clear benefits of betterment in cognitive abilities should intend that patients should be given the chance to take the drug.