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Galantamine More Efffective and Less Costly Than Other Drugs in its Class: Presented at IADRD

By Patrice Olson
Special to DG News

STOCKHOLM, SWEDEN -- July 22, 2002 -- Galantamine is more effective and less costly than either donepezil or rivastigmine, according to findings presented here at the 8^th International Conference on Alzheimer's Disease and Related Disorders.

The three drugs are acetylcholinesterase inhibitors (AChEIs) available for the treatment of Alzheimer's disease (AD).

Dr. Jaime Caro, director of the Caro Research Institute, in Concord, Massachusetts, United States, and multi-centre colleagues incorporated efficacy and tolerability data from Cochrane meta-analyses of each of the three AChEIs into the AHEAD model, a common analytic framework. The AHEAD model forecasts requirement for full-time care (FTC) as well as death over a period of 10 years with predictive equations derived from follow-up data on 236 patients with AD.

The cost of treating patients with each of the three AChEIs was derived from the Canadian Study of Health and Aging and represents costs in Canadian dollars as of 2001.

Analysis first revealed that the daily cost of treating patients was $4.59 for each of the three drugs. On the other hand, galantamine dominated both donepezil and rivastigmine in terms of efficacy and lower costs, the investigators found. Compared with donepezil, 5 and 10 mg a day, galantamine at a dose of 16 mg decreased time in FTC by 0.8 percent to 3.9 percent, thereby reducing costs by $323 to $2,166 per patient.

Galantamine 16 mg also resulted in lower costs of up to $4,015 per patient, and 4.6 percent to 7.5 percent less FTC, compared to rivastigmine.

Donepezil 10 mg was superior to rivastigmine at all doses. However, at 5 mg, the incremental benefit of donepezil relative to rivastigmine 6 mg to 12 mg was obtained at a cost of $522 or $158,875 by quality-adjusted life years gained. In a separate multivariate, probabilistic sensitivity analysis, galantamine 6 mg also resulted in improved health costs in 59 percent to 100 percent of cases compared to donepezil and rivastigmine. In 98 percent of these cases, galantamine also reduced overall costs, thereby emerging as the dominant treatment option.

In the absence of treatment, patients with AD are expected to require FTC after an average of 38.4 months, with a mean total cost of caring for each patient exceeding $75,000. "Any projection of data from short-term trials to the long term always has the limitations" Dr. Caro said in an interview.

On the other hand, Dr. Caro felt that the strength of this particular analysis is that they applied the same economic model to all of the data, which is not always the case.

"When you make a decision about which drug to use, you have to do it with the available data. So I would say that given the data we have today, [galantamine] would be my first choice because it is likely to be as effective or perhaps a bit more effective [than other AChEIs], and somewhat less expensive," Dr. Caro concluded.

Dr. Caro conducted this study with colleagues at Caro Research Institute, in Dorval, Quebec, Canada, and Janssen-Ortho, Inc., in Toronto, Ontario, Canada.

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