Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Research, Society and Development |
Texto Completo: | https://rsdjournal.org/index.php/rsd/article/view/33846 |
Resumo: | Accelerated population aging has led to a progressive increase in dementia, particularly Alzheimer’s Disease (AD). The study’s objective was to perform a cost-utility analysis on the use of memantine in the severe stage of AD in Brazil compared to no specific pharmacological treatment from the perspective of the Brazilian Unified Health System (SUS). A Markov model was designed to simulate the progression of AD through five finite stages of health that considered cognitive function and a time horizon of five years. Progression probabilities were derived from clinical trials and population-based studies. Direct costs included hospitalization, medical consultation, use of additional medications, as well as laboratory tests. The measures for Quality Adjusted Life Year (QALY) were derived from the international literature. Costs and benefits were discounted by 5%. Compared to no specific pharmacological treatment, memantine was associated with gains in QALY and additional costs. The model showed that memantine resulted in a gain of 0.00308 QALY over the simulated 5 years and an increase in costs of R$351.50 per patient in already discounted values, resulting in an incremental cost-effectiveness ratio (ICER) of R$114,123.38 per QALY. The cost and effect of memantine on AD progression were the variables under the most uncertainty. Although memantine represents gains in QALY, its ICER is considered high for the Brazilian context considering its high costs and its small and limited benefit in time. |
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Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil Costo-utilidad de la memantina en la Enfermedad de Alzheimer en BrasilCusto-utilidade da memantina para Doença de Alzheimer no BrasilDoença de AlzheimerAnálise de Custo-efetividadeMemantinaSistema único de saúde.Enfermidad de AlzheimerAnálisis Costo-BenefícioMemantinaSistema único de salud.Alzheimer’s DiseaseCost-utility AnalysisMemantineUnified health system.Accelerated population aging has led to a progressive increase in dementia, particularly Alzheimer’s Disease (AD). The study’s objective was to perform a cost-utility analysis on the use of memantine in the severe stage of AD in Brazil compared to no specific pharmacological treatment from the perspective of the Brazilian Unified Health System (SUS). A Markov model was designed to simulate the progression of AD through five finite stages of health that considered cognitive function and a time horizon of five years. Progression probabilities were derived from clinical trials and population-based studies. Direct costs included hospitalization, medical consultation, use of additional medications, as well as laboratory tests. The measures for Quality Adjusted Life Year (QALY) were derived from the international literature. Costs and benefits were discounted by 5%. Compared to no specific pharmacological treatment, memantine was associated with gains in QALY and additional costs. The model showed that memantine resulted in a gain of 0.00308 QALY over the simulated 5 years and an increase in costs of R$351.50 per patient in already discounted values, resulting in an incremental cost-effectiveness ratio (ICER) of R$114,123.38 per QALY. The cost and effect of memantine on AD progression were the variables under the most uncertainty. Although memantine represents gains in QALY, its ICER is considered high for the Brazilian context considering its high costs and its small and limited benefit in time.El envejecimiento acelerado de la población ha provocado un aumento progresivo de la demencia, sobre todo de la enfermedad de Alzheimer (EA). El objetivo del estudio fue realizar un análisis de costo-utilidad sobre el uso de memantina en la etapa grave de EA en Brasil en comparación con ningún tratamiento farmacológico específico, en la perspectiva del Sistema Único de Salud (SUS). Se diseñó un modelo de Markov para simular la progresión de la EA a través de cinco etapas finitas de salud que consideraban la función cognitiva y un horizonte temporal de cinco años. Los costes médicos directos incluían las hospitalizaciones, las consultas médicas, el uso de memantina y de medicamentos adicionales, y las pruebas de laboratorio. Las medidas de QALY (Quality Adjusted Life Year) se derivaron de la literatura. Los costes y beneficios se descontaron al 5%. El uso de memantina, en comparación con ningún tratamiento farmacológico específico, se asoció con ganancias QALY y costos adicionales. El modelo mostró que la memantina resultó en una ganancia de 0,00308 QALY en los 5 años simulados y un aumento en los costos de R$ 351,50 por paciente en los valores ya descontados, resultando en una relación costo-efectividad incremental (RCEI) de R$ 114.123,38 por QALY. El coste y el efecto de la memantina sobre la progresión de la EA fueron las variables con mayor incertidumbre. Aunque la memantina represente ganancias en QALY, su RCEI es alto para la realidad brasileña, considerando sus altos costos y su pequeño beneficio, limitado en el tiempo.O envelhecimento populacional acelerado ocasiona um aumento progressivo dos quadros demenciais, sobretudo da Doença de Alzheimer (DA). O objetivo do estudo foi realizar uma análise de custo-utilidade acerca do uso da memantina para a DA no estágio grave em comparação a nenhum tratamento farmacológico específico, na perspectiva do Sistema Único de Saúde (SUS). Um modelo de Markov foi elaborado para simular a progressão da DA através de cinco estágios finitos de saúde que consideraram a função cognitiva e um horizonte temporal de cinco anos. As probabilidades de progressão foram derivadas de ensaios clínicos e estudos de base populacionais. Os custos médicos diretos incluíram hospitalizações, consultas médicas, uso da memantina e de medicamentos adicionais, além de testes laboratoriais. As medidas de anos de vida ajustados pela qualidade (QALY, Quality Adjusted Life Year) foram derivadas da literatura. Custos e benefícios foram descontados em 5%. O uso da memantina, comparada a nenhum tratamento farmacológico específico, esteve associado a ganhos em QALY e a custos adicionais. O modelo mostrou que a memantina resultou em um ganho de 0,00308 QALY ao longo dos 5 anos simulados e um aumento dos custos de R$ 351,50 por paciente em valores já descontados, resultando em uma razão de custo-efetividade incremental (RCEI) de R$ 114.123,38 por QALY. O custo e efeito da memantina na progressão da DA foram as variáveis sob maior incerteza. Apesar da memantina representar ganhos em QALY, sua RCEI é elevada na realidade brasileira, considerando custos elevados e um benefício pequeno e circunscrito no tempo.Research, Society and Development2022-09-02info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://rsdjournal.org/index.php/rsd/article/view/3384610.33448/rsd-v11i11.33846Research, Society and Development; Vol. 11 No. 11; e556111133846Research, Society and Development; Vol. 11 Núm. 11; e556111133846Research, Society and Development; v. 11 n. 11; e5561111338462525-3409reponame:Research, Society and Developmentinstname:Universidade Federal de Itajubá (UNIFEI)instacron:UNIFEIenghttps://rsdjournal.org/index.php/rsd/article/view/33846/28719Copyright (c) 2022 Ione Ayala Gualandi de Oliveira; Rosângela Caetano; Ricardo Ewback Steffen; Aline Navega Bizhttps://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessOliveira, Ione Ayala Gualandi deCaetano, RosângelaSteffen, Ricardo EwbackBiz, Aline Navega2022-09-05T13:24:46Zoai:ojs.pkp.sfu.ca:article/33846Revistahttps://rsdjournal.org/index.php/rsd/indexPUBhttps://rsdjournal.org/index.php/rsd/oairsd.articles@gmail.com2525-34092525-3409opendoar:2024-01-17T09:49:23.101284Research, Society and Development - Universidade Federal de Itajubá (UNIFEI)false |
dc.title.none.fl_str_mv |
Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil Costo-utilidad de la memantina en la Enfermedad de Alzheimer en Brasil Custo-utilidade da memantina para Doença de Alzheimer no Brasil |
title |
Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil |
spellingShingle |
Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil Oliveira, Ione Ayala Gualandi de Doença de Alzheimer Análise de Custo-efetividade Memantina Sistema único de saúde. Enfermidad de Alzheimer Análisis Costo-Benefício Memantina Sistema único de salud. Alzheimer’s Disease Cost-utility Analysis Memantine Unified health system. |
title_short |
Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil |
title_full |
Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil |
title_fullStr |
Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil |
title_full_unstemmed |
Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil |
title_sort |
Cost-utility analysis of memantine in Alzheimer’s Disease in Brazil |
author |
Oliveira, Ione Ayala Gualandi de |
author_facet |
Oliveira, Ione Ayala Gualandi de Caetano, Rosângela Steffen, Ricardo Ewback Biz, Aline Navega |
author_role |
author |
author2 |
Caetano, Rosângela Steffen, Ricardo Ewback Biz, Aline Navega |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Oliveira, Ione Ayala Gualandi de Caetano, Rosângela Steffen, Ricardo Ewback Biz, Aline Navega |
dc.subject.por.fl_str_mv |
Doença de Alzheimer Análise de Custo-efetividade Memantina Sistema único de saúde. Enfermidad de Alzheimer Análisis Costo-Benefício Memantina Sistema único de salud. Alzheimer’s Disease Cost-utility Analysis Memantine Unified health system. |
topic |
Doença de Alzheimer Análise de Custo-efetividade Memantina Sistema único de saúde. Enfermidad de Alzheimer Análisis Costo-Benefício Memantina Sistema único de salud. Alzheimer’s Disease Cost-utility Analysis Memantine Unified health system. |
description |
Accelerated population aging has led to a progressive increase in dementia, particularly Alzheimer’s Disease (AD). The study’s objective was to perform a cost-utility analysis on the use of memantine in the severe stage of AD in Brazil compared to no specific pharmacological treatment from the perspective of the Brazilian Unified Health System (SUS). A Markov model was designed to simulate the progression of AD through five finite stages of health that considered cognitive function and a time horizon of five years. Progression probabilities were derived from clinical trials and population-based studies. Direct costs included hospitalization, medical consultation, use of additional medications, as well as laboratory tests. The measures for Quality Adjusted Life Year (QALY) were derived from the international literature. Costs and benefits were discounted by 5%. Compared to no specific pharmacological treatment, memantine was associated with gains in QALY and additional costs. The model showed that memantine resulted in a gain of 0.00308 QALY over the simulated 5 years and an increase in costs of R$351.50 per patient in already discounted values, resulting in an incremental cost-effectiveness ratio (ICER) of R$114,123.38 per QALY. The cost and effect of memantine on AD progression were the variables under the most uncertainty. Although memantine represents gains in QALY, its ICER is considered high for the Brazilian context considering its high costs and its small and limited benefit in time. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-09-02 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://rsdjournal.org/index.php/rsd/article/view/33846 10.33448/rsd-v11i11.33846 |
url |
https://rsdjournal.org/index.php/rsd/article/view/33846 |
identifier_str_mv |
10.33448/rsd-v11i11.33846 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://rsdjournal.org/index.php/rsd/article/view/33846/28719 |
dc.rights.driver.fl_str_mv |
https://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
https://creativecommons.org/licenses/by/4.0 |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Research, Society and Development |
publisher.none.fl_str_mv |
Research, Society and Development |
dc.source.none.fl_str_mv |
Research, Society and Development; Vol. 11 No. 11; e556111133846 Research, Society and Development; Vol. 11 Núm. 11; e556111133846 Research, Society and Development; v. 11 n. 11; e556111133846 2525-3409 reponame:Research, Society and Development instname:Universidade Federal de Itajubá (UNIFEI) instacron:UNIFEI |
instname_str |
Universidade Federal de Itajubá (UNIFEI) |
instacron_str |
UNIFEI |
institution |
UNIFEI |
reponame_str |
Research, Society and Development |
collection |
Research, Society and Development |
repository.name.fl_str_mv |
Research, Society and Development - Universidade Federal de Itajubá (UNIFEI) |
repository.mail.fl_str_mv |
rsd.articles@gmail.com |
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1797052797599875072 |