The pharmacoeconomic assessment of the rationality of the use of memantine and its combinations with acetylcholinesterase inhibitors in the treatment of dementia in Alzheimer’s disease in Ukraine

Authors

DOI:

https://doi.org/10.24959/sphhcj.24.330

Keywords:

dementia; acetylcholinesterase inhibitors; memantine; pharmacoeconomic assessment; Alzheimer’s disease

Abstract

Aim. To conduct the pharmacoeconomic assessment of the rationality of using memantine and its combinations with acetylcholinesterase inhibitors in the treatment of dementia in Alzheimer’s disease in Ukraine.

Materials and methods. Historical, analytical and comparative, systematic, graphic, logical, hypothetical-deductive, as well as marketing, pharmacoeconomic, and mathematical and statistical methods of analysis were used. The pharmacoeconomic studies were conducted using the cost-effectiveness method. CER and ICER indicators were calculated for dementia treatment regimens in Alzheimer’s disease containing memantine and its combinations with acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) in the period of 12 and 24 weeks of their use. The pharmacoeconomic analysis used data on the clinical effectiveness of dementia treatment regimens in Alzheimer’s disease presented in the Sochrane library (ID Number: CN-01071444; Accession Number: PUBMED 25932260e).

Results. It was found that despite the clinical advantages of using the memantine+galantamine regimen proven by scientists according to the MMSE scale, the use of the memantine+rivastigmine regimen seemed to be rational (CER1 = 23.13 and CER2 = 34.57 USD/unit of increased efficiency). The clinical and economic benefits of using the memantine+galantamine regimen in the treatment of dementia patients with Alzheimer’s disease were proven in the 12- and 24-week regimen (MMSE scale). In the case of using the AADL scale, it was rational, from the point of view of economical use of resources, in the 12-week regimen of treating patients, the use of the memantine + rivastigmine regimen was less expensive (CER1 = 18.30 $/unit of AADL score reduction), while in the 24-week regime it was the memantine + placebo regimen (CER2 = $37.58 $/ unit of AADL score reduction).

Conclusions. The research results presented can be used in forming drug purchases carried out by specialized healthcare institutions under the conditions of limited budget funding and growing needs of psychoneurological patients in effective medical and pharmaceutical care.

References

Srivastava S., Ahmad R. Khare S. K. (2021) Alzheimer’s disease and its treatment by different approaches: a review. Eur. J. Med. Chem., 216, 113320. Available at: https://pubmed.ncbi.nlm.nih.gov/33652356.

Aisen, P. S., Cummings, J., Jack Jr, C. R., Morris, J. C., Sperling, R., Frölich, L. et al. (2017). Alzheimer’s Research & Therapy, 9(60). doi: 10.1186/s13195-017-0283-5.

Porsteinsson, A. P., Isaacson, R. S., Kno, S., Sabbagh, M. N., Rubino, I. (2021). J. Prev. Alzheimer’s Dis., 8(3), 371–386. doi: 10.14283/jpad.2021.23.

Orgeta, V., Mukadam, N., Sommerlad, A., Livingston, G. (2019) The Lancet Commission on Dementia Prevention, Intervention, and Care: a call for action. Ir. J. Psychol. Med., 36(2), 85–88. doi: 10.1017/ipm.2018.4.

Shao Zi-Qiang (2015). Comparison of the efficacy of four cholinesterase inhibitors in combination with memantine for the treatment of Alzheimer’s disease. Int J Clin Exp Med., 8(2), 2944–2948. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402907/.

Veitc, D. P., Weiner, M. W., Aisen, P. S., Beckett, L. A., Cairns, N. J., Green, R. C. et al. (2019). Alzheimer’s. Alzheimer’s & Dementia, 15(1), 106–152.

Dos Santos Picanco, L. C., Ozela, P. F., de Fatima de Brito Brito, M., Pinheiro, A. A., Padilha, E. C., Braga, F. S. et al. (2018). Alzheimer’s disease: a review from the pathophysiology to diagnosis, new perspectives for pharmacological treatment. Curr Med Chem, 25, 3141–3159.

Ehsan Yaghmaei, Hongxia Lu, Louis Ehwerhemuepha, Jianwei Zheng. (2024). Comparative safety and effectiveness of cholinesterase inhibitors and memantine for Alzheimer’s disease: a network meta-analysis of 41 randomized controlled trials. Communications Medicine, 4(99). Available at: https://www.nature.com/articles/s43856-024-00527-6.

Li, D.-D., Zhang, Y.-H., Zhang, W., Zhao, P. (2019). Meta-Analysis of Randomized Controlled Trials on the Efficacy and Safety of Donepezil, Galantamine, Rivastigmine, and Memantine for the Treatment of Alzheimer’s DiseaseFront. Neurosci., 13, 472. doi: 10.3389/fnins.2019.00472. eCollection 2019.

Fedotova, M., Panfilova, H., Hala, L., Lebedyn, A., Simonian, L., Gerush, O. et al. (2022). Evaluation of the state of pharmaceutical supply of patients with dementia with Alzheimer disease in Ukraine in accordance with international recommendations. ScienceRise: Pharmaceutical Science, 4(38), 53–61. doi: 10.15587/2519-4852.2022.263415/.

MOZ Ukrainy Nakaz No. 736 vid 19.07.2016 Pro zatverdzhennia “Unifikovanoho klinichnoho protokolu pervynnoi, vtorynnoi (spetsializovanoi), tretynnoi (vysokospetsializovanoi) ta paliatyvnoi medychnoi dopomohy. Dementsiia”. Available at: https://www.dec.gov.ua/wp-content/uploads/2019/11/2016_736_ykpmd_dem.pdf.

Sims, J. R., Zimmer, J. A., Evans, C. D., Lu, M., Ardayfio, P., Sparkset, J. D. al. (2023). Donanemab in Early Symptomatic Alzheimer Disease: The TRAILBLAZER-ALZ 2 Randomized Clinical Trial. JAMA, 330(6), 512–527. doi: 10.1001/jama.2023.13239.

Cummings, J., Aisen, P. S., Du Bois, B., Frölich, L., Jack, Jr. C. R., Jones R. W. et al (2016). Drug development in Alzheimer’s disease: the path to 2025. Alzheimers Res Ther., 8, 39. doi: 10.1186/s13195-016-0207-9.

van Dyck, C. H., Swanson, C. J., Aisen, P., Bateman, R. J., Chen, C., Gee, M. et al. (2023). Lecanemab in early Alzheimer’s disease. N Engl J Med., 388(1), 9–21. doi: 10.1056/NEJMoa2212948.

Mintun, M. A., Lo, A. C., Duggan, E. C., Wessels, A. M., Ardayfio, P. A., Andersen, S. W. et al. 2021Donanemab in early Alzheimer’s disease. N Engl J Med., 384(18), 1691–1704. doi: 10.1056/NEJMoa2100708.

Jiaxun Guo, Zhenyu Wang, Ruishu Liu, Yunxia Huang, Nan Zhang, Ruihan Zhang. (2020). Memantine, donepezil, or combination therapy–what is the best therapy for Alzheimer’s Disease? A network meta-analysis. Brain Behav., 10(11), e01831. doi: 10.1002/brb3.1831.

Kai-Xin Dou, Meng-Shan Tan, Chen-Chen Tan, Xi-Peng Cao, Xiao-He Hou, Qi-Hao Guo et al. (2018). Comparative safety and effectiveness of cholinesterase inhibitors and memantine for Alzheimer’s disease: a network meta-analysis of 41 randomized controlled trials. Alzheimer’s Research & Therapy., 10(1), 126. doi: 10.1186/s13195-018-0457-9.

Ehsan Yaghmaei, Albert Pierce, Hongxia Lu, Yesha M Patel, Louis Ehwerhemuepha, Ahmad Rezaie et al. (2023). A causal inference study: the impact of the combined administration of Donepezil and Memantine on decreasing hospital and emergency department visits of Alzheimer’s disease patients. PLoS ONE., 18(9), e0291362. doi: 10.1371/journal.pone.0291362. eCollection 2023.

Dan-Dan Li, Ya-Hong Zhang, Wei Zhang, Pu Zhao. (2019). Meta-Analysis of Randomized Controlled Trials on the Efficacy and Safety of Donepezil, Galantamine, Rivastigmine, and Memantine for the Treatment of Alzheimer’s Disease. Front. Neurosci, 13, 472. doi: 10.3389/fnins.2019.00472.

King C., Khoury R., Grossberg G. T. (2018). An evaluation of memantine ER + donepezil for the treatment of Alzheimer’s disease. Expert Opin Pharmacother, 19(15), 1711-1717. doi: 10.1080/14656566.2018.1519022. Epub 2018 Sep 23.

Tseng, P. T., Zeng, B. Y., Chen, Y. W., Yang, C. P., Su, K. P., Chen, T. Y. et al. (2022). The Dose and Duration-dependent Association between Melatonin Treatment and Overall Cognition in Alzheimer’s Dementia: A Network Meta- Analysis of Randomized Placebo-Controlled Trials. Curr Neuropharmacol, 20(10), 1816–1833. doi: 10.2174/1570159X20666220420122322.

Hellweg, R., Wirth, Y., Janetzky, W., Hartmann, S. (2012). Efficacy of memantine in delaying clinical worsening in Alzheimer’s disease (AD): responder analyses of nine clinical trials with patients with moderate to severe AD. Int. J Geriatr Psychiatry, 27(6 (6)), 651-656. doi: 10.1002/gps.2766. Epub 2011 Aug 25.

Mc Shane, R., Areosa Sastre, A., Minakaran, N. (2006). Memantine for dementia. Cochrane Database Syst Rev, 2, CD003154. doi: 10.1002/14651858.CD003154.pub5.

Anees Shajhan Ebrahem, Mark Oremus (2018). A pharmacoeconomic evaluation of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s disease. Expert Opinion on Pharmacotherapy, 19(11), 1245–1259. doi: 10.1080/14656566.2018.1499727.

Nemchenko, A. S. Farmakoekonomichna otsinka. Farmatsevtychna entsyklopediia. Available at: https://www.pharmencyclopedia.com.ua/article/8353/farmakoekonomichna-ocinka.

Matushchak, M. R., Panfilova, H. L. (2023). Farmakoekonomichna otsinka ratsionalnosti zastosuvannia skhem khimioterapii, shcho mistiat imunoterapevtychni preparaty, u likuvanni klasychnoi limfomy Khodzhkina. Farmatsevtychnyi zhurnal, (3), 68–81.

Shao Zi-Qiang. (2015). Comparison of the efficacy of four cholinesterase inhibitors in combination with memantine for the treatment of Alzheimer’s disease. Int J Clin Exp Med., 8(2), 2944-8. Available at: https://pubmed.ncbi.nlm.nih.gov/25932260.

Arevalo‐Rodriguez, I., Smailagic, N., Figuls, M. R., Ciapponi, A., Sanchez‐Perez, E., Giannakou, A. et al. (2021). Mini‐Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane database of systematic reviews. Cochrane Database Syst Rev., 7(7), CD010783. doi: 10.1002/14651858.CD010783.pub3.

Mlinac, M. E., Feng, M. C. (2016). Assessment of Activities of Daily Living, Self-Care, and Independence. Archives of Clinical Neuropsychology, 31(6), 506–516 doi: 10.1093/arclin/acw049.

Yakovlieva, L. V., Mishchenko, O. Ya. Farmakoekonomichnyi analiz. Farmatsevtychna entsyklopediia. Available at: https://www.pharmencyclopedia.com.ua/article/288/farmakoekonomichnij-analiz.

Standart. Nastanova. Derzhavna otsinka medychnykh tekhnolohii dlia likarskykh zasobiv. ST-N MOZU 42-9.1:2021. Available at: https://www.dec.gov.ua/wp-content/uploads/2021/omt/Attitude.pdf.

Downloads

Published

2024-12-05

Issue

Vol. 10 No. 3 (2024)

Section

Social marketing and pharmacoeconomic research

License

Copyright (c) 2024 National University of Pharmacy

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).