The cost-utility of the rivastigmine transdermal patch in the management of patients with moderate Alzheimer's disease in the US

A novel rivastigmine transdermal patch has recently been approved in the US for the treatment of Alzheimer's disease (AD) and Parkinson's disease dementia (PDD). The current objective was to model the incremental cost-utility of the rivastigmine patch versus best supportive care (BSC; no active treatment) in the management of AD, from the perspective of a US payer.

The incremental costs and number of institutional days avoided with the rivastigmine patch versus BSC over 5 years were calculated using an economic model. Changes in Mini Mental State Examination (MMSE) scores over a 5-year period were used as a measure of the progression of AD. The clinical pathway was populated based on the results of a large clinical trial, with 12-month follow-up data from patients who received the rivastigmine patch (n=383) and 6-month follow-up data from patients who received placebo (n=282). Progression of the disease was modeled beyond the study period using published equations to predict the natural decline of MMSE in AD patients. Costing variables included drugs and community care and institutionalization.

The rivastigmine patch was shown to actually save $1,986 per patient and help avoid 64.3 institutional days over 5 years, proving it to be a dominant strategy over BSC. One-way sensitivity analysis suggested that the main determinants of cost-effectiveness were: the likelihood of institutionalization; the relationship between MMSE states and quality of life; and the analytic perspective adopted.

In this model, the rivastigmine patch has a more favorable cost-effectiveness profile compared with many treatments currently reimbursed by US health care agencies. Further research studies focusing on effects on activities of daily living to demonstrate cost effectiveness and benefits of treatment are warranted.