Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer's disease in Germany using discrete event simulation

Rates of change were modeled using trial and registry-based patient level data. A discrete event simulation projected outcomes for three identical patient groups: donepezil 10 mg, memantine 20 mg and no therapy. Patient mix, mortality and costs were developed using Germany-specific sources.Treatment of patients with mild to moderately severe AD with donepezil compared to no treatment was associated with 0.13 QALYs gained per patient, and 0.01 QALYs gained per caregiver and resulted in average savings of €7,007 and €9,893 per patient from the healthcare system and societal perspectives, respectively. In patients with moderate to moderately-severe AD, donepezil compared to memantine resulted in QALY gains averaging 0.01 per patient, and savings averaging €1,960 and €2,825 from the healthcare system and societal perspective, respectively.In probabilistic sensitivity analyses, donepezil dominated no treatment in most replications and memantine in over 70% of the replications. Donepezil leads to savings in 95% of replications versus memantine.Donepezil is highly cost-effective in patients with AD in Germany, leading to improvements in health outcomes and substantial savings compared to no treatment. This holds across a variety of sensitivity analyses.Alzheimer's disease (AD) is an incurable neurodegenerative disease characterized by cognitive decline, impairment of daily activities and neuropsychiatric symptoms. AD patients lose the ability to perform higher-level daily activities and decrease to being no longer able to perform basic daily necessities such as eating or grooming [1]. Mood swings, apathy, psychosis or agitation are behavioral symptoms commonly observed with AD patients. With increasing severity of the disease dealing with the patients' symptoms can become an increasing burden to caregivers.A recent study reported the prevalence of dementia in Germany a under 1% of 60-64 year olds and significantly increasing to roughly 20% for those over the 85-89 year old