The cost-benefit of cholinesterase inhibitors in mild to moderate XXXX : a willingness-to-pay approach.

@entity303 @entity1 @entity195
OBJECTIVE: This study aimed to measure the economic value of cholinesterase inhibitors when used to treat @entity195 using the willingness-to-pay (WTP) approach and the framework of cost-benefit analysis. METHODS AND STUDY DESIGN: A cost-benefit analysis using the WTP approach was employed. The study sample consisted of 28 nonprofessional caregivers of outpatients with mild to moderate @entity303 from Toronto, ON, Canada. The caregivers were presented with four scenarios. In the first scenario, scenario A, a hypothetical @entity1 with mild @entity303 was stabilised with a cholinesterase inhibitor. In the second scenario, scenario A with adverse effects, the above @entity1 (A) experienced adverse effects caused by the drug. In the third scenario, scenario B, the @entity1 exhibited behavioural symptoms in addition to mild @entity303 , and both were stabilised with the drug. In the fourth scenario, scenario B with adverse effects, the above @entity1 (B) experienced adverse effects caused by the drug. The caregivers were then asked what amount they would pay, in Canadian dollars, each year to buy the medication, assuming that they were the caregivers of the @entity1 described. A multivariate regression analysis was performed to assess the relationship between the demographic data (including the caregiver's yearly income) and the WTP. The average WTP was also predicted for the general population and the elderly population of Canada using data from Statistics Canada, and these values were compared with the cost of the medication. STUDY PERSPECTIVE: Nonprofessional caregiver perspective. All monetary values are 1999 values unless otherwise specified. RESULTS: The mean yearly WTP was  Can4540 (95% CI 2334-6746) for scenario A,  Can3686 (95% CI 1530-5842) for scenario A with adverse effects,  Can5003 (95% CI 2661-7345) for scenario B and  Can4486 (95% CI 2222-6750) for scenario B with adverse effects. The WTP decreased when drug adverse effects were present (significantly in scenario A; p = 0.04), but did not significantly increase when behavioural symptoms were present and stabilised. In all scenarios, caregiver yearly income was the only significant predictor of WTP, in the direction expected. For all scenarios, the calculated WTPs from the regression analysis using our sample mean, the average Canadian population data and the elderly population data were all higher than the yearly cost of the cholinesterase inhibitors, with the net benefit ranging from  Can1723 to  Can4508. CONCLUSIONS: The results of the study, from a small sample of nonprofessional caregivers, revealed that the caregivers are willing to pay more for cholinesterase inhibitors than the drugs cost, even when the adverse effects of the drugs are taken into consideration. This indicates a net benefit for cholinesterase inhibitors in the treatment of mild to moderate @entity303 from a consumer's point of view.
