Original Title: Análisis de la eficacia de los tratamientos y coste de la enfermedad de Alzheimer en la CAPV

Authors' objectives: To undertake a review of the clinical trials analysing the efficacy of the different drugs used, across distinct scales of measures. These scales are utilised to find out the progression of the illness (Alzheimer's Disease Assessment Scale-ADAS, Progressice Deteroration Scale-PDS, etc...). To carry out an economic analysis of the health/social impact of this illness in the Basque Country.

Authors' results and conclusions: ADAS and PDS are the only cognitive and functional scales developed and validated specifically for the moderate phases of Alzheimer's Disease (AD). In terms of the drugs currently used in the treatment of this pathology (nimodipine, piracetam, hydergine, tacrine and donepezile), they are not really effective. The only two commercially available dugs which are specifically for the treatment of AD, tacrine and donepezile contribute a benefit which is reflected in a slight improvement of 3-4 points on the ADAS cognitive scale, it is presented on a scale from 0 to 70, but does not entail an improvement in the patient's quality of life. The total cost of treating AD in the BAC during 1997 has been at least 54,541 million pesetas (US$ 352 millions). The social cost (nursing homes, day centers, home help, help from family and friends) comes to represent 98.4% of the total annual cost in the treatment of this pathology.

Authors' recommendations: The current treatments available are not really effective for the following reasons: the methodological problems found in the clinical trials undertaken up to now (sensitivity of the patient, measuring instruments, test instability, the selection of patients, the abandoning of treatment, blind study and reaction to placebo), the little improvement that has been seen and whether this continues over the long term. The result of this is that it is not possible to perform a complete economic evaluation, so a health/social cost analysis of the illness has been undertaken. The informal costs (help from family/friends) are a serious burden on our society (89% of the total annual cost), as the majority of these patients are treated in the home.

Authors' methods: - Bibliographical search in Medline (1966-1997), Embase (1974-1997), Cross, Iowa Drug Information System (1985-1997), HealthStar and Cochrane Library (1st. Trim. 1998). - The selection of the relevant scientific evidence. - Synthesis of the selected bibliography and helath technology assessment reports. The value of the costs was carried out from the health care perspective and societal perspective. - The time period is one year and the assumption has been made that the prevalence of AD in >64 years of age is 4%. - Synthesis of the hospital costs relating to the AD (ICD-9: 331.0) for 1995 to 97, cost of the tacrine prescription drug, costs of the external, interhospital, neurological consultations and costs relating with social services.

Project Status: Completed

Year Published: 1998

URL for published report: https://www.euskadi.eus/contenidos/informacion/1998_osteba_publicacion/es_def/adjuntos/1998/d_98_01_tratamientos_alzheimer.pdf

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment), Health Department of the Basque Government</p>