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Original article

Vol. 142 No. 4748 (2012)

Alzheimer’s dementia: budget impact and cost-utility analysis of a combination treatment with a cholinesterase inhibitor and memantine in Switzerland

  • Alena M. Pfeil
  • Reto W. Kressig
  • Thomas D. Szucs
Cite this as:
Swiss Med Wkly. 2012;142:w13676


QUESTIONS UNDER STUDY: The objective of this study was to estimate the potential budget impact and cost-effectiveness of the combination treatment of a cholinesterase inhibitor and memantine in Switzerland.

METHODS: The prevalence of dementia according to European sources and future Swiss population data were used to estimate the number of patients with Alzheimer’s dementia in Switzerland. Both direct and indirect costs calculated from Swiss sources were included. Utility estimates and transition probabilities were obtained from the published literature. A Markov model was used for the cost-utility analysis in order to calculate incremental cost-effectiveness ratios from a health care and a societal perspective.

RESULTS: Assuming mono treatment (either a cholinesterase inhibitor or memantine), treatment costs would increase from CHF 22.7 million in 2012 to CHF 26.1 million in 2016, the additional yearly treatment costs for the combination treatment (cholinesterase inhibitor and memantine) would be between CHF 1.7 million and CHF 1.9 million. The Markov model compared health care costs of the mono treatment to costs of the combination treatment over five years. From a health care perspective, the combination treatment saved CHF 27,655 per patient over five years and CHF 248,895/quality adjusted life year compared to the mono treatment.

CONCLUSIONS: Implementation of the reimbursed combination treatment would incur additional treatment costs of about CHF 10 million over five years. From a health care perspective, the combination treatment would decrease costs over five years by CHF 50 million. Based on long term considerations, the combination treatment was the dominant strategy over the mono treatment.


  1. Jalbert JJ, Daiello LA, Lapane KL. Dementia of the Alzheimer type. Epidemiol Rev. 2008;30:15–34.
  2. Harvey HJ, Rossor MN, Skelton-Robinson M, Garralda E. Young onset dementia: epidemiology, clinical symptoms, family burden, support, and outcome. Dementia Research Group. Imperial College of Science, Technology and Medicine. London: 1998.
  3. Hofman A, Rocca WA, Brayne C, Breteler MMB, Clarke M, Cooper B, et al. The prevalence of dementia in Europe: a collaborative study of 1980–1990 findings. Int J Epidemiol. 1991;20(3):736.
  4. Wimo A and Prince M. World Alzheimer Report 2010: the global economic impact of dementia. Alzheimer’s Disease International. 2010.
  5. Volz A, Monsch AU, Zahno A, Wettstein A, Stähelin HB, Grünig R. Was kostete die Schweiz die Alzheimer-Krankheit 1998? Eine präliminäre Analyse. Praxis. 2000;89:803–11.
  6. Sadik K and Wilcock G. The increasing burden of Alzheimer disease. Alzheimer Dis Assoc Disord. 2003;17:S75–S79.
  7. Wimo A, Winblad B, Jönsson L. The worldwide societal costs of dementia: Estimates for 2009. Alzheimer’s & Dementia. 2010;6:98–103.
  8. Gauthier S, Molinuevo JL, Lemming O. Effects of memantine in patients with moderate to severe Alzheimer’s disease receiving stable doses of donepezil: a meta-analysis. Poster presented at the 10th International Conference on Alzheimer’s & Parkinson’s Diseases, 2011
  9. Atri A, Shaughnessy LW, Locascio JJ, and Growdon JH. Long-term course and effectiveness of combination treatment in Alzheimer disease. Alzheimer Dis Assoc Disord. 2008;22(3):209–21.
  10. Lopez OL, Becker JT, Wahed AS, Saxton J, Sweet RA, Wolk DA, et al. Long-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease. J Neurol Neurosurg Psychiatry. 2009;80:600–7.
  11. Tariot PN, Farlow MR, Grossberg GT, Graham SM, McDonald S, Gergel I. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil. JAMA. 2004;291(3):317–24.
  12. Howard R, McShane R, Lindesay J, Ritchie C, Baldwin A, Barber R, et al. Donepezil and memantine for moderate-to-severe Alzheimer’s disease. N Engl J Med. 2012;366:893–903.
  13. Farrimond LE, Roberts E, McShane R. Memantine and cholinesterase inhibitor combination therapy for Alzheimer’s disease: a systematic review. BMJ Open. 2012;2(3):e000917.
  14. Kraft E, Marti M, Werner S, Sommer H. Cost of dementia in Switzerland. Swiss Med Wkly. 2010;140:w13093
  15. Rive B, Aarsland D, Grishchenko M, Cochran J, Lamure M, Toumi M. Cost-effectiveness of memantine in moderate and severe Alzheimer’s disease in Norway. Int J Geriatr Psychiatry. 2011. Epub ahead of print. doi: 10.1002/gps.2755.
  16. Hoogveldt B, Rive B, Severens J, Maman K, Guilhaume C. Cost-effectiveness of memantine for moderate-to-severe Alzheimer’s disease in the Netherlands. Neuropsychiatr Dis Treat. 2011;7:313–7.
  17. Rive B, Grishchenko M, Guilhaume-Goulant C, Katona C, Livingston G, Lamure M, et al. Cost effectiveness of memantine in Alzheimer’s disease in the UK. J Med Econ. 2010;13(2):371–80.
  18. Gagnon M, Rive B, Hux M, Guilhaume C. Cost-effectiveness of memantine compared with standard care in moderate-to-severe Alzheimer disease in Canada. Can J Psychiatry. 2007;52(8):519–26.
  19. François C, Sintonen H, Sulkava R, Rive B. Cost-effectiveness of memantine in moderately severe to severe Alzheimer’s disease: A Markov model in Finland. Clin Drug Investig. 2004;24(7):373–84.
  20. Antonanzas F, Rive B, Badenas JM, Gomez-Lus S, Guilhaume C. Cost-effectiveness of memantine in community-based Alzheimer’s disease patients: an adaption in Spain. Eur J Health Econ. 2006;7:137–44.
  21. Jones RW, McCrone P, Guilhaume C. Cost-effectiveness of memantine in Alzheimer’s disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging. 2004;21(9):607–20.
  22. Jönsson L. Cost-effectiveness of memantine for moderate to severe Alzheimer’s disease in Sweden. Am J Geriatr Pharmacother. 2005; 3(2):77–86.
  23. Lachaine J, Beauchemin C, Legault M, Bineau S. Economic evaluation of the impact of memantine on time to nursing home admission in the treatment of Alzheimer disease. Can J Psychiatry. 2011;56(10):596–604.
  24. Touchon J, Lachaine J, Beauchemin C, Crochard A, Rive B, Bineau S. Memantine delays the admission of Alzheimer’s disease patients to nursing home: cost-effectiveness analysis in the French setting. Poster presented at the 13th ISPOR Annual European Congress, 2010.
  25. ECOPLAN. Kosten der Demenz in der Schweiz – Schlussbericht. Studie im Auftrag der Schweizerischen Alzheimervereinigung. Bern: 2010.
  26. Bundesamt für Statistik. Ständige Wohnbevölkerung 2011. Available from: Access at: 20 October 2011
  27. Bundesamt für Statistik. Zukünftige Bevölkerungsentwicklung der Schweiz in den Jahren 2012-2016. Available from: Access at: 20 October 2011
  28. Schweizerische Alzheimervereinigung. Zahlen zur Demenz – Kosten der Demenz in der Schweiz: Update 2009. Available from: Access at: 3 October 2011.
  29. CSS Gruppe. FaktenBlatt Gesundheitspolitik – Fragen und Antworten zur Kosten- und Prämienentwicklung im Gesundheitswesen. Available from: documents/ueber_uns/themen_im_fokus/faktenblatt_d_kostenentwicklung.pdf Access at: 17 November 2011
  30. Schweizerische Alzheimervereinigung. Demenz und Gesellschaft – Fakten zur Demenz. Available from: Access at: 20 October 2011
  31. IMS Health. Antidementia drugs in Europe and USA – percentage of population treated with antidementia drugs from 2005–2009 [Graphic].
  32. Tifratene K, Le Duff F, Pradier C, Quetel R, Robert P. Usage des medicaments anti-Alzheimer en France: une analyse des pratiques à partir de la Banque Nationale de données Alzheimer (BNA). La Revue de gériatrie. 2011;36(8):557–65.
  33. Haute Autorité de Santé – Médicaments: EBIXA Available from: Access at: 6December 2011
  34. Ward A, Caro JJ, Getsios D, Ishak K, O’Brien J, Bullock R; AHEAD Study Group. Assessment of health economics in Alzheimer’s disease (AHEAD): treatment with galantamine in the UK. Int J Geriatr Psychiatry. 2003;18(8):740–7.
  35. Neumann PJ, Kuntz KM, Leon J, Araki SS, Hermann RC, Hsu MA, et al. Health utilities in Alzheimer’s disease: a cross-sectional study of patients and caregivers. Med Care. 1999;37(1):27–32.
  36. Helmer C, Joly P, Commenges D, Dartigues J-F. Mortality with dementia: results from a French prospective community-based cohort. Am J Epidemiol 2001;154:642–8.
  37. Bundesamt für Statistik. Apotheken/SD-Ärzte Index Schweiz. Available from: Access at: 17 November 2011
  38. WHO. Cost-effectiveness thresholds. Available from: /CER_thresholds/en/index.html Access at: 6 December 2011
  39. NICE. Measuring effectiveness and cost-effectiveness: the QALY. Available from: Access at: 6 December 2011
  40. PharmaWiki – Medikamente und Gesundheit: Donepezil. Available from: Access at: 30April 2012.
  41. Mein Gesundheitszentrum – Alzheimer: Aricept. Available from: Access at: 30April 2012.
  42. Arzneimittel-Kompendium der Schweiz® – Donepezil. Available from: Access at: 7August 2012.