Skip to main content Accessibility help

Use of cognitive enhancers and associated medical care costs among patients with dementia: a nationwide study in Taiwan

  • Li-Jung E. Ku (a1) and Ming-Chyi Pai (a2)



Pharmaceutical therapy for patients with dementia including cholinesterase inhibitors (ChEI) and memantine is covered by Taiwan's National Health Insurance (NHI) but with strict reimbursement criteria. This study compared utilization of selected cognitive enhancers among elderly patients with dementia and estimated associated differences in medical care costs.


This study used medical claims and pharmacy claims from the NHI Research Database of Taiwan from 2009 to 2011, which included all patients 65 years or older diagnosed with dementia in their outpatient or inpatient claims. Both individual-level and market-level analysis were performed to calculate the average medical costs per person and the share of drug expenditures. Generalized linear models with propensity score adjustment estimated differences in medical care costs by use of selected cognitive enhancers.


Users of ChEI had the highest medication and outpatient costs but the lowest inpatient costs among all users of cognitive enhancers. However, annual adjusted total medical care costs per ChEI user were not significantly different from those who used cerebral vasodilators (CBV). In 2011, 52.4% of the elderly with dementia in Taiwan used cognitive enhancers, but among them 88.3% used CBV while 9.2% used ChEI. Among patients with dementia who used at least one cognitive enhancer, the aggregated expenditure as a share of their total drug expenditures was 9.7% in 2011.


Given that CBV had a much higher utilization rate than ChEI or memantine among elderly people with dementia, the strict reimbursement policy for ChEI and memantine may need to be revisited to increase access to those drugs by patients with dementia in Taiwan.


Corresponding author

Correspondence should be addressed to: Ming-Chyi Pai, MD, PhD, Division of Behavioral Neurology, Department of Neurology and Alzheimer's Disease Center, Medical College and Hospital, National Cheng Kung University, 138, Sheng Li Road, North District, Tainan City 704, Taiwan. Phone: +886-6-2353535, ext: 5534; Fax: +886-6-2088036. Email:


Hide All
Austin, P. C., Grootendorst, P. and Anderson, G. M. (2007). A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study. Statistics in Medicine, 26, 734753.
Bond, M. et al. (2012). The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of technology appraisal no. 111): a systematic review and economic model. Health Technology Assessment (Winchester, England), 16, 1470.
Bureau of National Health Insurance (2013). Reimbursement Rule of Drugs Acting on the Nervous System. Taipei.
Cappell, J., Herrmann, N., Cornish, S. and Lanctôt, K. (2010). The pharmacoeconomics of cognitive enhancers in moderate to severe Alzheimer's disease. CNS Drugs, 24, 909927.
Chien, I. C. et al. (2008). Treated prevalence and incidence of dementia among national health insurance enrollees in Taiwan, 1996–2003. Journal of Geriatric Psychiatry and Neurology, 21, 142148.
Chou, L. F., Chang, C. W., Fu, J. L. and Wang, S. J. (2000). The economic costs of dementia in Taiwan. Journal of National Chengchi University, 82, 126.
Deyo, R. A., Cherkin, D. C. and Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with icd-9-cm administrative databases. Journal of Clinical Epidemiology, 45, 613619.
Directorate General of Budget Accounting and Statistics (DGBAS) (2013). Consumer Price Index. Taipei, Taiwan.
Erkinjuntti, T., Ostbye, T., Steenhuis, R. and Hachinski, V. (1997). The effect of different diagnostic criteria on the prevalence of dementia. New England Journal of Medicine, 337, 16671674.
Fillit, H. and Hill, J. (2004). The economic benefits of acetylcholinesterase inhibitors for patients with Alzheimer disease and associated dementias. Alzheimer Disease & Associated Disorders, 18, S24–S29.
Hill, J. W., Futterman, R., Duttagupta, S., Mastey, V., Lloyd, J. R. and Fillit, H. (2002a). Alzheimer's disease and related dementias increase costs of comorbidities in managed medicare. Neurology, 58, 6270.
Hill, J. W., Futterman, R., Mastey, V. and Fillit, H. (2002b). The effect of donepezil therapy on health costs in a medicare managed care plan. Managed Care Interface, 15, 6370.
Hirano, K. and Imbens, G. W. (2001). Estimation of causal effects using propensity score weighting: an application to data on right heart catheterization. Health Services and Outcomes Research Methodology, 2, 259278.
Hyde, C. et al. (2013). Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model. Age Ageing, 42, 1420.
Johnell, K., Religa, D. and Eriksdotter, M. (2013). Differences in drug therapy between dementia disorders in the Swedish dementia registry: a nationwide study of over 7,000 patients. Dementia and Geriatric Cognitive Disorders, 35, 239248.
Laroche, M.-L., Charmes, J.-P. and Merle, L. (2007). Potentially inappropriate medications in the elderly: a French consensus panel list. European Journal of Clinical Pharmacology, 63, 725731.
Lin, P. J., Kaufer, D. I., Maciejewski, M. L., Ganguly, R., Paul, J. E. and Biddle, A. K. (2010). An examination of Alzheimer's disease case definitions using medicare claims and survey data. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 6, 334341.
Liu, H.-C. et al. (1998). Prevalence and subtypes of dementia in a rural Chinese population. Alzheimer Disease & Associated Disorders, 12, 127139.
Lopez, O. L., McDade, E., Riverol, M. and Becker, J. T. (2011). Evolution of the diagnostic criteria for degenerative and cognitive disorders. Current Opinion in Neurology, 24, 532541.
Lu, S., Hill, J. and Fillit, H. (2005). Impact of donepezil use in routine clinical practice on health care costs in patients with Alzheimer's disease and related dementias enrolled in a large medicare managed care plan: a case-control study. The American Journal of Geriatric Pharmacotherapy, 3, 92102.
Marin, D. et al. (2003). Impact of rivastigmine on costs and on time spent in caregiving for families of patients with Alzheimer's disease. International Psychogeriatrics, 15, 385398.
Mauskopf, J. and Mucha, L. (2011). A review of the methods used to estimate the cost of Alzheimer's disease in the United States. American Journal of Alzheimer's Disease and Other Dementias, 26, 298309.
Mihaylova, B., Briggs, A., O’Hagan, A. and Thompson, S. G. (2011). Review of statistical methods for analysing healthcare resources and costs. Health economics, 20, 897916.
Mimica Matanović, S. and Vlahovic-Palcevski, V. (2012). Potentially inappropriate medications in the elderly: a comprehensive protocol. European Journal of Clinical Pharmacology, 68, 11231138.
Montastruc, F. et al. (2013). Potentially inappropriate medication use among patients with Alzheimer disease in the real.Fr cohort: be aware of atropinic and benzodiazepine drugs! European Journal of Clinical Pharmacology, 69, 15891597.
Mucha, L., Wang, S. S., Cuffel, B., McRae, T., Mark, T. L. and Valle, M. d. (2008). Comparison of cholinesterase inhibitor utilization patterns and associated health care costs in Alzheimer's disease. Journal of Managed Care Pharmacy, 14, 11.
Sun, Y., Lai, M. S., Lu, C. J. and Chen, R. C. (2008). How long can patients with mild or moderate Alzheimer's dementia maintain both the cognition and the therapy of cholinesterase inhibitors: a national population-based study. European Journal of Neurology, 15, 278283.
Taiwan Alzheimer's Disease Association (2013). A nationwide survey on the prevalence of mild cognitive impairment and dementia including very mild dementia in Taiwan.
Vellas, B., Froelich, L. and Sampaio, C. (2007). Commentary on “health economics and the value of therapy in Alzheimer's disease.” Value therapy for Alzheimer's disease–a European perspective. Alzheimers Dement, 3, 152156.
Wilmo, A. and Prince, M. (2010). World Alzheimer Report 2010: The Global Economic Impact of Dementia. London: Alzheimer's Disease International.
Wimo, A., Winblad, B., Stöffler, A., Wirth, Y. and Möbius, H.-J. (2003). Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer's disease. PharmacoEconomics, 21, 327340.
Yang, Z., Zhang, K., Lin, P. J., Clevenger, C. and Atherly, A. (2012). A longitudinal analysis of the lifetime cost of dementia. Health Services Research, 47, 16601678.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed