When Alzheimer’s patients receive a cholinesterase inhibitor such as donepezil, rivastigmine, or galantamine, it can delay the need to place them in a nursing home. And when they receive the NMDA receptor antagonist memantine plus a cholinesterase inhibitor, it can delay this placement even longer.

These findings, by O.L. Lopez, M.D., a professor of neurology at the University of Pittsburgh, and colleagues have since been replicated by other researchers in North America and Europe, Lopez told Psychiatric News.

Thus, if the use of memantine plus a cholinesterase inhibitor can delay nursing-home placement longer than the use of a cholinesterase inhibitor alone, can it also save money?

The answer is yes, Jean Lachaine, Ph.D., an associate professor of pharmacy at the University of Montreal, and colleagues reported in the October 2011 Canadian Journal of Psychiatry.

Specifically, it can save about $21,000 per patient annually (in either Canadian or American dollars) from a societal perspective, and about $31,000 per patient annually from a health care system perspective.

Therefore, “the use of memantine, combined with a cholinesterase inhibitor, to treat Alzheimer’s is a cost-effective alternative, compared with the use of a cholinesterase inhibitor alone,” they concluded.

In this analysis, they used data published by Lopez and his group as well as health care cost data published by Canadian researchers, including a large-scale Canadian epidemiologic study called the Canadian Study of Health and Aging, which is the primary reference for the costs of Alzheimer’s in Canada. The costs considered included items such as medications, patient care in the community or by home health aid workers, lost productivity of caregivers due to time spent caring for patients, and nursing home costs. The costs were adjusted to 2010 values using the Canadian Consumer Price Index.

Lachaine and his colleagues also found, as other researchers have, that placing Alzheimer’s patients in a nursing home represents the largest cost component of managing their care.

Lachaine and his colleagues either work for Lundbeck Inc. or consult to it. Lundbeck markets drugs for the treatment of Alzheimer’s, as well as for other neurological or psychiatric conditions.

An abstract of “Economic Evaluation of the Impact of Memantine on Time to Nursing Home Admission in the Treatment of Alzheimer Disease” is posted at http://publications.cpa-apc.org/media.php?mid=1232.