Purpose: The purpose of this study was to describe the patterns of use of cholinesterase inhibitors (ChEIs), a class of drug for the treatment of the symptoms of Alzheimer's disease and related dementias, and to assess associated health resource utilization and costs to the healthcare system of Ontario: Canada’s largest province. Dementia leads to progressive cognitive and functional decline. Three ChEIs – donepezil, galantamine, and rivastigmine – are covered under Ontario’s provincial drug formulary. There has been little research regarding their economic impact.
Method: This study described the patterns of use of ChEIs, and assessed healthcare resource utilization and costs in Ontario. Anonymized patient-level data from seven of Ontario’s health administrative databases were linked at the Institute for Clinical and Evaluative Sciences at Queen’s University. First-time users of ChEIs aged 66 years and older were identified between April 1st, 2004 and March 31st, 2009, and were followed until treatment discontinuation or up to one year following their index date. Health resource use was classified into six care categories: prescription drugs, physicians, long-term care, home care nursing service, emergency department, and hospitalizations. Chi-square, Kruskal-Wallis ANOVA and linear regression were employed to compare resource use between users of the three ChEIs. Costs were reported in 2010 Canadian dollars.
Result: In the cohort (N=40,057), the majority were prescribed donepezil (n=24,347), were female (60.5%) and had at least one other co-morbid disease. The odds of discontinuation were 1.47 (1.36, 1.60) and 1.26 (1.17, 136), higher for rivastigmine users than galantamine and donepezil users, respectively. Between 2005 and 2008, overall healthcare costs increased from $95.2 million to $106.1 million. Prescription drugs comprised 33% of all healthcare costs. ChEIs accounted for half of all prescription drug costs. Overall mean annual healthcare system cost per patient was $12,679.47 ($12,510.86, $12,848.08). Predictors of overall healthcare costs included long-term care, co-morbidity status, hospitalization and hip fractures.
Conclusion: Prescription drugs account for a substantial proportion of healthcare costs for patients with dementia, and the amount attributable to ChEIs alone is significant. Knowing the health service utilization patterns for dementia patients can help healthcare professionals and decision-makers plan patient care and timely resource allocation. The results stress the utility of administrative databases for evaluating the impact of health technologies on healthcare systems.
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