Alzheimer's dementia: budget impact and cost-utility analysis of a combination treatment of a cholinesterase inhibitor and memantine in Switzerland.

QUESTIONS UNDER STUDY The objective of this study was to estimate the potential budget impact and cost-effectiveness of the combination treatment of a cholinesterase inhibitor and memantine in Switzerland. METHODS The prevalence of dementia according to European sources and future Swiss population data were used to estimate the number of patients with Alzheimer's dementia in Switzerland. Both direct and indirect costs calculated from Swiss sources were included. Utility estimates and transition probabilities were obtained from the published literature. A Markov model was used for the cost-utility analysis in order to calculate incremental cost-effectiveness ratios from a health care and a societal perspective. RESULTS Assuming mono treatment (either a cholinesterase inhibitor or memantine), treatment costs would increase from CHF 22.7 million in 2012 to CHF 26.1 million in 2016, the additional yearly treatment costs for the combination treatment (cholinesterase inhibitor and memantine) would be between CHF 1.7 million and CHF 1.9 million. The Markov model compared health care costs of the mono treatment to costs of the combination treatment over five years. From a health care perspective, the combination treatment saved CHF 27,655 per patient over five years and CHF 248,895/quality adjusted life year compared to the mono treatment. CONCLUSIONS Implementation of the reimbursed combination treatment would incur additional treatment costs of about CHF 10 million over five years. From a health care perspective, the combination treatment would decrease costs over five years by CHF 50 million. Based on long term considerations, the combination treatment was the dominant strategy over the mono treatment.