TABLE 123Degree of uncertainty in model assumptions and impact on the cost-effectiveness of the AChEIs

IssueEvidence sourceLevel of uncertainty in dataImpact of uncertainty in modelOverall rating of importance in cost-effectiveness results
Assuming a treatment effect on survivalNo published RCT or epidemiological evidence.
Survival prediction allows treatment survival effect
HighHighVery important
Treatment discontinuationsFinal time point data from RCTsHighHighVery important
Costs in institutional careInflated 20-year-old estimates from 92 individualsHighModerateImportant
Effectiveness evidenceMix of different quality RCTsModerateLowModerate
Patient's health-state utilityProxy respondents or self-rated from published literatureModerateModerateImportant
Carer's health-state utilityPoor published evidenceHighLowModerate
Percentage of costs in institutional care funded by NHS/PSSPoor published evidence plus expert opinionHighModerateModerate
Costs in pre-institutional stateInflated 11- to 20-year-old estimates from 92 individualsHighModerateModerate
Cost of treatment-monitoring visitNHS Reference Costs 2008–9 217LowLowLow
Percentage starting model in institutional carePublished epidemiological study and author assumptionHighLowNot important
Baseline characteristicsStatistical analysis of 92 individualsLowLowNot important
Cost of drugsBNF compared with some poor reporting of doses used in RCTsModerateModerateModerate

From: 6, The Peninsula Technology Assessment Group cost–utility assessment

Cover of The Effectiveness and Cost-Effectiveness of Donepezil, Galantamine, Rivastigmine and Memantine for the Treatment of Alzheimer's Disease (Review of Technology Appraisal No. 111): A Systematic Review and Economic Model
The Effectiveness and Cost-Effectiveness of Donepezil, Galantamine, Rivastigmine and Memantine for the Treatment of Alzheimer's Disease (Review of Technology Appraisal No. 111): A Systematic Review and Economic Model.
Health Technology Assessment, No. 16.21.
Bond M, Rogers G, Peters J, et al.
Southampton (UK): NIHR Journals Library; 2012 Apr.
© 2012, Crown Copyright.

Included under terms of UK Non-commercial Government License.

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