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