Drug Development to Evidence Based Medi

Prevalence , cost
and likely market of Dementia

- Rohit Shrivastav
MSc Drug Development with Bio - busines
25th February 2010
Overview of the presentation
• History
• Introduction
• Prevalence
• Risk factors
• Prevention
• Cost of treatment
• Market of dementia treatment
•
•
•
History
When Dementia was 1 st reported ?
•
• In 1901, 1st case of dementia (now known
as Alzheimer) was reported in a 51 year
old woman at Frankfurt asylum named
Mrs. Auguste Deter.
• 1st case of dementia was noticed by Dr.
Aloysius "Alois" Alzheimer, a German
psychiatrist and neuropathologist .
•

Mrs. AugusteDeter Dr. Aloysius "Alois"

 Introduction
What is Dementia ?

•
ment , •
aphasia , apraxia , agnosia and
fers to any condition that causes a loss
Dementia
Predisposing
problem
ofsolving
brain
Factors
that
,cells interferes
and
Chronic use of alcohol
with normal
deterioration activities
of mental
and chronic sleep functio
deprivation

Dementia could be Static – due to brain injury

skills including reasoning and judgment are significantly
Progressive – due to impaired without
long term loss
decline inofmental
consciousnes
abilit
tion in mental illness like depression and psychosis produces symptoms of Delirium, which

20-30 % of the Dementia patients suffer from depression and anxiety. Agitation, aggression and delusion also accompany
Dementia.
Prevalence
• As of 2008, there are an estimated 30 million people with
 dementia worldwide. By 2050, it is projected that this figure
 will increase to over 100 million.

No. of people affected by dementia in South-east
Asia in Indonesia
Singapore 2005 Malaysia Myanmar Philippines Thailand Viet Nam
• Alzheimer's disease accounts for more than 50% of cases of
No. of 22,000
dementia 600,000 60,000
in Caucasian 130,000 175,000 250,000
populations. 275,000
•people
•
affected
There are about 683,597 people with dementia that accounts for
with 1.1% of the entire UK population.
Dementi
•a
• The total number of people with dementia in the UK is forecasted
to increase to 940,110 by 2021 and 1,735,087 by 2051.

•
• Dementia mainly affects older people. However, it can affect
younger people- there are 15,034 people in the UK under the
age of 65 who have dementia.
Former US President Ronald Regan suffered from Alzheimer’s disease and died at the age
• of 93 years in 2004.
isk o f d e ve lo p in g d e m e n tia

•
•
•
•
•
•
• from Dementia UK: The Full Report to the Alzheimer's
Adapted
Society produced by King's College London and the London School of
•
Economics

•
•
Risk factors for Dementia
Who gets Dementia ?
Areas of brain affected in
Dementia
 Treatment
Is there any treatment for Dementia ?
Two types of treatment for dementia has been described by NICE.
1.Psychological & Behavioural treatment.
2.Medical treatment.

Psychological & Behavioural approach has been recommended as best first choice treatment by NICE
for people with dementia. Stimulation of the brain, such as keeping it active through doing
crosswords or puzzles, is thought to help in slowing down the development of dementia.

Reality orientation therapy aims to reorient the person with dementia to time, place
carers under the supervision Psychological
of a health professional
& . ItBehavioural
helps to improve depression in people with de
treatment
RO therapy slows cognitive decline and means that people with dementia can have prolong

nsory stimulation uses a variety of measures, including lighting, relaxing music, sounds, massage cus
ng
cesand conversational
agitation activities
, confusion administered
, apathy and by carers
improves mood . The with
in people sessions concentrate
dementia . on information proces
ovement in memory is not sure.
Exercise for general fitness
 Medical treatment of dementia …

• There is no known treatment available that can reverse the effects of dementia.
Treatments are aimed at managing the symptoms of dementia.
• Drugs are used to treat cognitive symptoms, behavioural symptoms, depression,
anxiety and sleep problems.

•
pt),•galanatamine (brand name Reminyl), tacrine (cognex) & rivastigmine (Exelon)
Medical . Treatment
that work by preventing the breakdown of acetylcholine
epression in people with dementia include tricyclic antidepressants and the SSRIs. Antidepressants may

•
•
• of dementia. But there is a risk of side-effects such as excessive sedation, dizziness. Risperido
stages
Glutamate blockers
to treat anxiety in people with dementia . Short -acting
Ebixadrugs are preferred
glutamate.to long-acting drugs. Benzod
• Memantine (brand name ) inhibits
Used to treat memory and nerve cell damage.

•
•
Prevention
Can Dementia be prevented?

• Research has revealed that there are several factors that

can prevent or delay the onset of dementia in some
people.
•
• Studies have shown that people who maintain tight control
over their glucose levels have better cognitive function
than those with poorly controlled diabetes .
•
• Several studies also have suggested that people who
engage in intellectually stimulating activities, such as
social interactions, chess, crossword puzzles and playing
a musical instrument have significantly lower risk of
developing Alzheimer's disease and other forms of
dementia.
•
• Other preventive actions include lowering homocysteine
Cost associated with dementia
• Economic impact of Dementia
• Total treatment of late-onset dementia costs £17.03 billion, or
an average of £25,472 per person. Included in this amount
is the estimated £690 million in lost income for those carers
who have to give up employment or cut back their work
hours. This lostProportion
employmentofProportion
meansofaHourly
loss ofhome
£123care cost in
million
older
taxes paid to the people older
Exchequer. people of Attendance
Receipt
Allowance or DLAin receipt of whotoreceive
amounted around £919 million per
year, increasinghome care cost
to total day of
care
about £18 billion.
• 3.9%
• England
Total expenditure on dementia 1.7%. £9.20
is projected to-increase
£22.10 by 45
per cent to £34.6 billion in 2026. £740- £187 per person
Scotland 6.9% 1.3% per year
•
• This increase
Wales is primarily
4.3% due1.6%
to an estimated
£17.6 increase in
Northern
service costs for people with dementia -of £9.0 billion. Costs
willIreland
increase by2.4111
% per cent
1.1 %to £47.5 billion if the real pay
and price effect is taken into account – again, primarily due
to the impact of dementia.
•
• The cost of lost employment, currently estimated to be £26.1
billion, is projected to increase by 7.7 per cent to £28.1
World Market
Drug makers prospects for Alzheimer ’ s gold
• Worldwide societal cost estimate for dementia of US$315.4 billion.

•
• Drug Market for symptomatic drugs is worth US$50.4 Billion (United
States, France, Germany, Italy, Spain, the United Kingdom, and
Japan accounts for US$ 5.5 Billion) .

•
• The currently used symptomatic drugs are Aricept ($2.5 Bn annually)
from Eisai & Pfizer and other two major drug manufacturers in this
market are Novartis and Johnson & Johnson.

•
• The estimate for total cost of dementia in some countries (direct costs
plus informal care) in 2005
 Singapore was US$391 million. Indonesia was US$2,128 million;
 Malaysia was US$511 million Myanmar was US$118 million;
 Philippines
Alzheimer's was
patients areUS$601
in dire million
need of Thailand
a disease -was US$1,330
stopping million;
drug , and the company
 that comes up with one could harvest
Viet Nam was US$751 million. tens of billions of dollars in annual sales .
Cost-effective treatment
Drug makers prospects for Dementia ’ s gold

• Dementia is associated with high healthcare and social

costs.

•
• Psychological & Behavioural approach has been
recommended as best first choice treatment by NICE for
people with dementia. Stimulation of the brain, such as
keeping it active through doing crosswords or puzzles, is
thought to help in slowing down the development of
dementia.

•
• NICE guidelines recommends treatment of people with
moderate dementia, but not mild dementia, with AChIs
as cost-effective within the NHS.

•
• Early detection and intervention services can lead to a
reduced need for services at a later stage and therefore
cost savings.
References
• Ferri, C., et al. (2005). Study of dementia prevalence.
 The Lancet . Vol 366.2112-2117
• Medline Plus, 2010 [available online]
http://www.nlm.nih.gov/medlineplus/ency/imagepages/1714
• Medicine.net 2009 [available online]
http://www.medicinenet.com/dementia_pictures_slideshow/
• NHS choices, 2009 [available online]
http://www.nhs.uk/Conditions/Dementia/Pages/Diagnosis.as
• About.com, 2009 [available online]
http://alzheimers.about.com/od/diagnosisofalzheimers/tp/Ty
• Wrong diagnosis, 2010 [ available online]
http://www.wrongdiagnosis.com/a/alzheimers_
 disease/book-diseases-4c.htm
 •


Thank You