Galantamine is one of several orally administered
cholinesterase inhibitors that improve cognition in patients with mild to moderate
Alzheimer's disease. Compared with placebo,
galantamine 16 or 24 mg/day improved cognition and
activities of daily living, delayed emergence of behavioural symptoms and reduced caregiver burden in three pivotal randomised studies of 5 or 6 months' duration.
Galantamine may reduce the considerable economic burden of
Alzheimer's disease by delaying the need for full-time care (
FTC) in patients with mild to moderate
Alzheimer's disease. In pharmacoeconomic analyses with a time horizon of 10 years conducted in Canada, Sweden, The Netherlands and the US, data from the pivotal trials were incorporated into a model to examine economic implications associated with
galantamine treatment.
FTC was defined in the model as the consistent requirement for caregiving and supervision for the greater part of each day regardless of the location of care and the identity of caregiver. When the effect of
galantamine 16 or 24 mg/day was analysed from the perspective of a comprehensive healthcare payer, treatment was associated with cost savings (inclusive of drug costs) relative to no treatment, regardless of country for which the model was customised. Cost savings resulted from the delay in the time until
FTC was required in patients with mild to moderate disease. In sensitivity analyses, cost savings were most sensitive to the cost of institutional care. In the analyses that considered the effect of
galantamine 24 mg/day solely on cognition,
galantamine was predicted to reduce the time
FTC was required by approximately 10% in patients with mild to moderate
Alzheimer's disease compared with no pharmacological treatment. Greater reductions in the time that
FTC was required were predicted when the effects of
galantamine 16 or 24 mg/day on behavioural symptoms in addition to cognition were considered in the US analysis or in sensitivity analyses in studies in other countries. In conclusion, pharmacoeconomic analyses, which were based on modelling of data from pivotal clinical trials with
galantamine and included drug costs, indicate that
galantamine treatment may result in cost savings from a healthcare payer perspective. The effects of
galantamine on cognition and behavioural symptoms in patients with mild to moderate
Alzheimer's disease are predicted to delay the need for
FTC, which may result in cost savings. From a societal perspective, the caregiver burden of caring for a patient with
Alzheimer's disease in the community may be decreased and the time that patients have without severe disease may be prolonged.