Avaliação do custo efetividade do tratamento da Doença de Alzheimer leve e moderada no Brasil.

Abstract

The Brazilian Clinical Protocol and Therapeutic Guidelines establishes the use of cholinesterase inhibitors for mild to moderate Alzheimer's disease. Treatment have been criticized for offering modest benefits being insufficient to justify their high costs. This study aims to conduct a cost effectiveness analysis of donepezil and rivastigmine in mild and moderate Alzheimer s disease, from the perspective of the Unified Health System. Three scenarios were compared: donepezil, rivastigmine and natural history of the disease. The Markov transition model was used to simulate the effectiveness and costs of treatments. The transitional stages were defined according to cognitive function assessed using the Mini-Mental State Examination. Details of the costs were taken from Unified Health System information systems and the transition probabilities of Alzheimer's disease were taken from international clinical trials. Time horizon adopted was 10 years. A discount rate of 5% to the costs and clinical consequences was used. By Markov analysis, the mild dementia met a QALY of 0.61/R$ 21,907.38 for patients treated with donepezil and 0.58/R$ 24,683.33 for rivastigmine. In the moderate stage of the disease were observed QALY of 0.05/R$ 27,414.96 for donepezil and 0.06/R$ 34,222.96 for rivastigmine. The result of the study indicates that donepezil treatment is more cost effective for mild to moderate Alzheimer s disease then other options considered.