SAVINGS FROM SUB-GROUPS?: POLICY GUIDANCE AND ALZHEIMER’S DISEASE TREATMENTS

Background: A range of new therapeutic agents are now available for the management of Alzheimer’s disease. With limited resources available however, policy-makers and other health care professionals have to prioritise and judge competing treatments on criteria such as the magnitude of clinical effectiveness and costeffectiveness. Policy guidance that restricts treatments to defined patient sub-groups can improve the costeffectiveness of treatments, and can help limit rises in health care expenditures. Budget impact models that estimate the amount of additional costs and potential savings are being increasingly used by policy-makers. However, the amount of savings estimated in such models depends on the effectiveness of treatment in changing morbidity, and the association between morbidity and costs. Aim: To examine the magnitude of cost savings arising from provision of treatment to different patient sub-groups, using policy guidance decisions made by the National Institute for Health and Clinical Excellence (NICE) for cholinesterase inhibitor therapies in Alzheimer’s Disease (AD) in the United Kingdom National Health Service (NHS). Method: Cohort simulation modelling. Results: Policy guidance decisions that restricted treatment to smaller patient sub-groups were associated with lower overall care costs, but did not reduce drug costs. Conclusions: Given increasing recognition by health policy-makers of the importance of affordability of new treatments, greater attention should be paid to measurement of cost impacts by sub-groups within health economic modelling