Post on 29-Dec-2015
LISA JOHNSON & SUZANNE GRIESEL
MPH 543 LEADERSHIP AND ORGANIZATIONAL BEHAVIOR
FEBRUARY 16 , 2014
Funding Analysis of Alzheimer’s Treatment Options: Three Cholinesterase Inhibitors
Alzheimer’s Disease
A progressive, degenerative disorderAttacks the brain’s nerve cells or neurons.Causes the following:
loss of memory ability to think behavioral changes loss of language skills
Most common cause of dementia or loss of intellectual function
Not attributable to normal aging.
Risk Factors Associated with Alzheimer’s Disease
AgeGenetic profileEnvironmentalDietExerciseMentally stimulating pursuits
Stages of Alzheimer’s Disease
Normal function; No impairmentVery mild cognitive decline with no dementia symptoms Early-stage Alzheimer’s with mild cognitive decline
with trouble rememberingMild/early-stage Alzheimer’s with moderate cognitive
decline increased forgetfulnessMid-stage Alzheimer’s with moderately severe
cognitive declineModerately severe Alzheimer’s with severe cognitive
decline Late stage Alzheimer’s with very severe cognitive
decline
Alzheimer’s Direct and Indirect Costs
2013 Costs of Alzheimer’s Disease in United States$203 Billion
Alzheimer’s Direct and Indirect Costs
Unpaid care hours = 17.5 billion in 2012Health careLong-term careHospiceAverage cost per Alzheimer’s patient is three
times higher than those without Alzheimer’s or dementia
Medicaid spending per Alzheimer’s patient is 19 times higher than average senior
Treatment Options: Three Cholinesterase Inhibitors
Generic Brand Name
Approved for Side Effects
Donepezil Aricept All stages of Alzheimer's
Nausea, vomiting, loss of appetite and increased frequency of bowel movements
Rivastigmine
Exelon Mild to moderate Alzheimer's
Nausea, vomiting, loss of appetite and increased frequency of bowel movements.
Galantamine
Razadyne Mild to moderate Alzheimer's
Nausea, vomiting, loss of appetite and increased frequency of bowel movements
Benefits of Three Cholinesterase Inhibitors
Delay worsening of symptoms for 6 to 12 months
Improves cognition behavior, activities of daily living, and global functioning
Reduce caregiver stressDelay time to nursing home placement
Donepezil (Aricept)
Tablet taken once a day, taken at nightStarting dose is 5 mg a day Therapeutic goal is 10 mg a day
Rivastigmine (Exelon)
Capsule or liquid taken once a day. Starting dose is 1.5 mg once a day, after two
weeks the dose is 1.5mg twice a day. Therapeutic goal is 6 to 12 mg a day, in two
doses each equal to half of the total. Greater risk of side effects at the higher
doses
Galantamine (Razadyne)
Tablet taken twice a day.Starting dose is 4 mg twice a day. If well tolerated the dose is increased to 8
mg twice a day and can be increased to 12 mg twice a day
Available in an “extended release” form as Razadyne ER that is designed to be taken once a day.
Alzheimer’s Disease Treatment Funding Decision
Background Costs vary from $70.00 to approximately $190.00 per
month. Effective in improving Alzheimer’s Disease symptoms
Factors in decision-making process Insurance prescription plans Senior prescription plans Prescription assistance programs
Determining Factors Side effects Benefits
Constraints on funding or treatment option Treatment is most effective in mild to moderate
Alzheimer’s Disease
Summary
Proceed with funding the three cholinesterase inhibitors for the treatment of Alzheimer’s Disease.
Benefits outweigh side effects.Impact costs associated with Alzheimer’s
Disease.Help find improvements for a Alzheimer's
disease cure.
References
Alzheimer’s Association [AA] (2014). Seven Staged of Alzheimer’s. Retrieved from http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
Alzheimer’s Foundation of America [AFA] (2014). Alzheimer’s Disease. Retrieved from http://www.alzfdn.org/
Alzheimer's Association [AA] (2014). Medications for memory loss. Alz.org. Retrieved from http://www.alz.org/alzheimers_disease_standard_prescriptions.asp#cholinesterase
Alzheimer's Association [AA] (2006). Fact sheet: fda-approved cholinesterase inhibitors. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=10&sqi=2&ved=0CHsQFjAJ&url=http%3A%2F%2Fwww.alznyc.org%2Faboutalz%2Fpdf%2FFS_Cholinesteraseinhibtors.pdf
References
National Institute on Aging [AIA] (2014). Alzheimer’s Disease Education and Referral Center. Retrieved from http://www.nia.nih.gov/alzheimers/topics/risk-factors-prevention
National Institutes of Health Senior Health [NIHSH] (2012). Alzheimer’s Disease. Retrieved from http://nihseniorhealth.gov/alzheimersdisease/causesandriskfactors/01.html
New York Consortium for Alzheimer Research and Education [NYCARE] (2003). Cholinesterase inhibitors: answers to frequently asked questions about their use. Retrieved from https://www.alznyc.org/newsletter/archieve/inserts/InsertFall03.pdf
Thompson. S. (2004). The benefits and risks associated with cholinesterase inhibitor therapy in Alzheimer's disease. National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15335298