Healthcare related costs associated with donepezil use in patients with very mild dementia due to Alzheimer's disease: A retrospective observational study.

Background: The cost-effectiveness of Donepezil in mild to severe Alzheimer's disease (AD) has been widely studied, but research on very mild dementia (VMD) remains limited. Objective: This retrospective observational study evaluated the efficacy of Donepezil in patients with VMD in two hospitals in southern Taiwan between 2011 and 2019. Methods: We recruited 909 VMD patients with a Clinical Dementia Rating (CDR) of 0.5 and used propensity score matching to create two groups: 352 receiving Donepezil and 352 not. Demographic data, Mini-Mental State Examination (MMSE), and healthcare costs were analyzed over 1-year and 3-year periods. Results: At baseline, Donepezil treatment was associated with lower inpatient, outpatient, and overall healthcare costs. After 1 year, outpatient drug costs increased, while inpatient drug costs decreased, leading to higher overall healthcare drug costs. Over 3 years, outpatient drug continued to rise, while inpatient drug costs remained stable, leading to higher overall healthcare drug costs. Donepezil users had significantly more outpatient visits, but inpatient admissions were unaffected. Patients receiving Donepezil were older and had lower MMSE; male gender, Parkinsonism, chronic lung disease, and liver disease were less common in this group. Conclusions: Although Donepezil users initially had lower healthcare costs, overall healthcare drug costs increased in the Donepezil group at both the 1-year and 3-year follow-ups, while inpatient drug costs were only reduced in the short term.