1. LISA JOHNSON & SUZANNE GRIESEL MPH 543 LEADERSHIP AND ORGANIZATIONAL BEHAVIOR FEBRUARY 16, 2014 Funding Analysis of Alzheimer’s Treatment Options: Three Cholinesterase Inhibitors

2. Alzheimer’s Disease A progressive, degenerative disorder Attacks 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.

3. Risk Factors Associated with Alzheimer’s Disease Age Genetic profile Environmental Diet Exercise Mentally stimulating pursuits

4. Stages of Alzheimer’s Disease Normal function; No impairment Very mild cognitive decline with no dementia symptoms Early-stage Alzheimer’s with mild cognitive decline with trouble remembering Mild/early-stage Alzheimer’s with moderate cognitive decline increased forgetfulness Mid-stage Alzheimer’s with moderately severe cognitive decline Moderately severe Alzheimer’s with severe cognitive decline Late stage Alzheimer’s with very severe cognitive decline

5. Alzheimer’s Direct and Indirect Costs 2013 Costs of Alzheimer’s Disease in United States $203 Billion

6. Alzheimer’s Direct and Indirect Costs Unpaid care hours = 17.5 billion in 2012 Health care Long-term care Hospice Average 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

7. Treatment Options: Three Cholinesterase Inhibitors GenericBrand NameApproved forSide Effects DonepezilAriceptAll stages of Alzheimer'sNausea, vomiting, loss of appetite and increased frequency of bowel movements RivastigmineExelonMild to moderate Alzheimer's Nausea, vomiting, loss of appetite and increased frequency of bowel movements. GalantamineRazadyneMild to moderate Alzheimer's Nausea, vomiting, loss of appetite and increased frequency of bowel movements

8. 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 stress Delay time to nursing home placement

9. Donepezil (Aricept) Tablet taken once a day, taken at night Starting dose is 5 mg a day Therapeutic goal is 10 mg a day

10. 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

11. 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.

12. 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

13. 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.

14. References Alzheimer’s Association [AA] (2014). Seven Staged of Alzheimer’s. Retrieved from http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp 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/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#cholineste rase http://www.alz.org/alzheimers_disease_standard_prescriptions.asp#cholineste rase 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=1 0&sqi=2&ved=0CHsQFjAJ&url=http%3A%2F%2Fwww.alznyc.org%2Faboutalz %2Fpdf%2FFS_Cholinesteraseinhibtors.pdf http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1 0&sqi=2&ved=0CHsQFjAJ&url=http%3A%2F%2Fwww.alznyc.org%2Faboutalz %2Fpdf%2FFS_Cholinesteraseinhibtors.pdf

15. 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 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 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 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 http://www.ncbi.nlm.nih.gov/pubmed/15335298