Pharmacoeconomic studies are health economic studies used increasingly by insurance companies, governments, and other providers of health services to decide whether to adopt a new drug. Because the efficacy of anti-AD drugs is not very great, the

issue of cost effectiveness was raised as soon as these drugs were approved for marketing. For example, in a study of donepezil’s effect on health care cost and utilization, potential savings derived from decrease in medical cost were found to be neutralized by increase in the direct cost due to the high cost of medication.12 Nevertheless, there is a trend indicating that these Inhibitors,research,lifescience,medical treatments have the potential to offer cost savings,12-14 but these trends are mostly expressed as economic models rather than real-life studies. For example, in some studies,13,15 tacrine reduced the cost of caring for an AD patient by reducing cost of both institutionalization and home care. Finally, in a recent. Canadian study, it was found that

rivastigmine delayed the transition to more severe stages of AD. As severity of Inhibitors,research,lifescience,medical illness is related to higher costs, the consequence of this delay is cost savings.16 The main limitation of pharmacoeconomic studies is that they are very rarely designed a priori to address pharmacoeconomic questions. Most often, they arc pivotal Inhibitors,research,lifescience,medical phase 3 drug trials, to which secondary measurements addressing pharmacoeconomics are added. Hence, they suffer from Inhibitors,research,lifescience,medical all the limitations of controlled trials (selected patient populations, restricted outcome measurements and laboratory instead of real life clinical care). Whose costs

are we measuring? In the final analysis, whether a treatment, intervention, or service is cost-effective depends very much on who is paying for it.17 Too often, “novel, innovative” interventions and services result in cost shifting rather than saving resources or providing better care. For example, depending on the organization of health care and the insurance status of the patient, the transfer of a patient from home to institutionalization may decrease the family out-of-pocket expenses and increase the insurer expenses, who now has to cover Inhibitors,research,lifescience,medical the cost of institutionalization. Similarly, a drug that delays institutionalization might increase Idoxuridine the expenses of the local authorities, which are often covering the cost of day-care centers, and decrease the cost of the private or governmental insurance agency that Regorafenib covers the cost of a nursing home. Finally, indirect cost related to the care provided for free by a healthy spouse or child has monetary meaning only if the caregiver can obtain gainful employment instead of being a caregiver. This is particularly relevant in AD where most of the caregivers are spouses who are often, but not always, retired. In this case, quality of life rather than cost is the relevant variable, but pricing the quality of life of a demented individual or even of an elderly caregiver is a daunting task.