Cholinesterase Inhibitors: A population-based assessment of resource utilization for patients with Alzheimer's dementia in Ontario
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Background: Dementia leads to progressive cognitive and functional decline. Population aging is a concern, and the healthcare system must refocus its limited resources to keep up with service demands. Three cholinesterase inhibitors (ChEIs) – donepezil, galantamine and rivastigmine – have been approved for the treatment of dementia and are covered under Ontario’s formulary plan, but there has been little research regarding their economic impact. Methods: The purpose of this study was to describe the patterns of use of ChEIs, and to assess associated health resource utilization and costs to Ontario’s healthcare system. Anonymized patient-level data from seven provincial 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, emergency department, and hospitalizations. Chi-square, Kruskal-Wallis ANOVA and linear regression were employed to compare resource use between users of the three ChEIs. Results: 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. Conclusions: 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 and the need for further research for this disease.