Prevalence of cholinesterase inhibitors in subjects with dementia in Europe

Purpose: To evaluate the prevalence of cholinesterase inhibitor (ChI) treatment in subjects with dementia in European countries.

Methods: We studied the prevalence of treatment in subjects with dementia among European countries in 2004 (Belgium, France, Germany, Italy, the Netherlands, Poland, Portugal, Spain and the United Kingdom) by using estimates of prevalence of dementia and of ChI treatments according to sales and reimbursement data.

Results: In 2004, estimated prevalence of ChI use among subjects with dementia ranged from 3.0% in the Netherlands to 20.3% in France. It was 17.5% in Spain, 6.7% in the UK and 5.9% in Italy. Donepezil was used by more than 60% of patients using a single ChI and represented almost 50% of reimbursements for patients that had used at least two different ChIs during the year. Galantamine and rivastigmine were respectively used by 22 and 18% of subjects using a single drug and 27 and 23% of reimbursements for patients that had used at least two different ChIs. Nevertheless, different patterns of use were found for individual countries.

Conclusions: Prevalence of treatment by ChIs among subjects with dementia remains weak and varies greatly across Europe. Differences in reimbursement rates and health policies could partly explain these variations, as ChIs could have failed to convince health authorities because the outcomes considered for trials are not used by clinicians in their everyday practice. If donepezil was highly predominant across countries, variations in rivastigmine and galantamine importance could reflect local market specificities.