DELAYS IN NURSING HOME PLACEMENT FOR PATIENTS WITH ALZHEIMER'S DISEASE ASSOCIATED WITH TREATMENT WITH DONEPEZIL MAY HAVE HEALTH CARE COST-SAVING IMPLICATIONS

OBJECTIVES: Donepezil, an anti-dementia drug, has been associated with delays in nursing home placement (NHP) for patients with Alzheimer's disease (AD). This analysis explores the health care cost-saving implications of such treatment. METHODS: Information on the dates and reasons for NHP was obtained through follow-up interviews with caregivers and chart reviews of 763 AD patients who participated in three randomized, double-blind, placebo-controlled clinical trials and two subsequent open-label studies of donepezil. Patients were categorized according to their experiences in utilizing donepezil during the clinical trials and extension studies. Cox proportional hazards models (adjusted for age, gender, baseline Mini-Mental Status Examination scores, caregiver status and post clinical study use of cholinesterase inhibitors) were used to estimate adjusted survival functions from which median times to NHP were estimated for each donepezil use category. Analyses of the relationship between donepezil use and time to NHP were completed for both first dementia-related placement (data reported here) and for permanent placement (data similar). Standard nursing home cost data were applied to these results. RESULTS: For the least exposure group (dose <5 mg/day and/or used drug for less than 8 weeks total; n = 95), the median time to first dementia-related NHP was 43 months. Compared with this group, patients who received at least 5 mg/day of donepezil for 8 weeks or more had a significantly (p < 0.05) longer time to first dementia-related NHP. For patients who received donepezil for at least 36 weeks (12 weeks of double blind and 24 weeks of open-label treatment, for example), the median time was 73 months to first dementia-related NHP (RR = 0.458, p < 0.01). CONCLUSIONS: Because nursing home care has been reported as the principal cost driver in the care of AD patients, these delays to the time of entry into a nursing home associated with donepezil treatment may have important health care cost-saving implications.