Drugs not cost effective?
November 5, 2012
A REVIEW of Pharmaceutical
Benefits Scheme anti-dementia
drugs to treat Alzheimer’s disease
has found that subsidised
prescriptions for continuing use of
cholinesterase inhibitors (CEIs)
donepezil, rivastigmine and
galantamine, and the N-methyl-Daspartate
receptor antagonist
memantine beyond six-months are
not cost effective.
The report, jointly prepared by
Centre for Health Economics,
Monash University, the University
of SA, and the Department of
Health and Ageing, is designed to
provide more recent evidence on
the effectiveness and cost
effectiveness of PBS subsidised CEIs
and memantine for the treatment
of dementia.
Donepezil, rivastigmine and
galantamine and memantine were
approved by the PBAC for dementia
in late 2000, however the approval
restricted the subsidy of the
medicines beyond six months to
only those patients who
demonstrated an improvement in
their symptoms.
A review conducted in 2009
however found that these
medicines were being prescribed to
more people (approximately 60% of
those who initiate treatment)
beyond six months than originally
expected.
The latest report also found
evidence to suggest that CEIs and
memantine are being used in a
significant population outside that
originally agreed by PBAC as cost
effective at the initial listing price.
Looking at the safety and efficacy
of the drugs, the new report
identified no more convincing
evidence reporting improvement in
quality of life outcomes or time to
institutionalisation compared to
those given a placebo, and also that
for patients treated with CEIs and
memantine, the average change or
improvement in cognitive ability
was less than that required to
continue receiving subsidised
treatment beyond six months.
The report also noted that the
number of patients on these drugs
improving in the PBS population is
likely to be lower, given those
enrolled in trials are on average
younger, are less likely to have
other medical illnesses and
are taking fewer medications that
have the potential to interact with
CEIs.
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