DESK REVIEWS | 07.05.07. What are the costs of the main antidementia medications: donepezil, galantamine, rivastigmine and memantine?

DESK REVIEW | 07.05.07. What are the costs of the main antidementia medications: donepezil, galantamine, rivastigmine and memantine?

The prices of the medicines vary per state according to federal/state taxation rates (as shown in the table below), and per laboratory. They are available for free in the SUS, but there is a bureaucratic and specific place where they can be obtained. Private patients may buy medication in pharmacies.

TAX Federal State Initials
20% RJ
18% AM, AP, BA, CE, MA, MG, PB, PE, PI, PR, RN, RS, SE, SP, TO and RJ
17.5% RO
17% Other states
12% Generic medicines in SP and MG

The Brazilian Health Regulatory Agency (ANVISA) establishes the maximum price a costumer can pay for each medicine. It may happen that a laboratory sells the same drug with different “brand names” which may impact on the final price of the medication. People living with dementia can get all these medications free of charge through the SUS.

Table 7.12. Cost per dose of generics as per the Clinical practice guideline management for dementia

Name of the medication Dose as per guidelines No. of brands/trades name  available Range of cost
Usual starting dose in mg/day Maximum recommended dose (mg/day)
Donepezil 5 10 28 Rs 105 – Rs 171 5Mg (10 tablets)

Rs 145- Rs 244 10 mg (10 tablets)

Rivastigmine 3 12 19 Rs 22 – Rs 710 1.5mg (10 capsules)
Galantamine 8 24   Rs 131- Rs 220 4 mg/ 10s
Rivastigmine Transdermal Patch 4.6/24 hours patch 9.5/24 hours patch 19 Rs 5497 / 30 pcs
Donepezil extended release 11.5 23 Rs 121- Rs 172 (10 tablets)
NMDA Antagonist Memantine 10 20 3 Rs 88- Rs 798 (10 tablets)

Source: (Medindia, 2019; Shaji et al., 2018)

References:

Medindia, 2019. Medindia – Trusted Information on Health & Wellness Available from: www.medindia.net/index.asp

Shaji, K.S., Sivakumar, P.T., Rao, G.P., Paul, N., (2018). Clinical Practice Guidelines for Management of Dementia. Indian J. Psychiatry 60, S312–S328. https://doi.org/10.4103/0019-5545.224472

Only donepezil is approved on the national formulary for dementia and Alzheimer’s. For donepezil film-coated tablet 5mg, the price varies according to province with higher prices seen in eastern regions of Indonesia, but the price range is around Rp. 1,700 to Rp. 2,200. There are other products registered at BPOM (Badan Pengawas Obat dan Makanan) as traditional supplements without specific dementia indication but can be found on locally popular e-commerce websites advertised as dementia medication at a much higher price. For example, Kapsul Esktrak Pegagan priced at Rp 250,000, citicoline 500mg (Rp 165,000), and Lycozein Softgel (Rp 450,000) (Wu, 2014).

References:

Wu, T. (2014). The Asian Family, the State and Care for Urban Older Adults: A Comparison of Singapore, China, and Indonesia. July.

Since they are not included on the essential drug list of drugs in Kenya (Ministry of Health, 2016a) and are unavailable in public facilities, the cost in private facilities is dependent on the distributor.

References:

Ministry of Health. (2016a). Kenya Essential Medical Supplies List 2016. Nairobi, Kenya. http://publications.universalhealth2030.org/uploads/KEMSL-2016Final-1.pdf

There was no publicly available information regarding prices within the public health services or social security institutions, as these are not included in the public sector medicine catalogues.

A rapid search of prices among private sector pharmacies (Metropolitan Area of Mexico City), where most people purchase them, given they are not usually covered by health or social security institutions, shows an average price for the main presentations of these four medications as follows:

  1. Clorhidrato de donepezilo: a) PEZZIL (torrent): 5mg / 28 tablets: $1,450.- MXN (around $74 USD)  b) Eranz (Pfizer) 5 mg / 28 tablets $2,150.- (around $113.- USD),
  2. Bromhidrato de galantamina: a) Reminyl ER (Jannsen-CILAG) 20.508 mg (equivalent to 16 mg of galantamine) / 14 capsules: 14: $1420 MXN (around $70.- USD),
  3. Clorhidrato de memantina a) Menural (Apopharma) 10 mg / 28 tablets: $640.- MXN (around $32.- USD), b) Ebixa (Lundbeck) 20 mg / 28 tablets: $1,500.- MXN; c) Akatinol (Merz) 20 mg / 28 tablets: $1650.- MXN ($83.- USD),
  4. Rivastigmina: Exelon patches (Novartis) 9.5 mg / 24 hours / 30 patches: $2,900.- MXN ($145.- USD).

Some pharmacies offer a discount of 5% for older adults if they are registered with INAPAM, the national older adults’ institute. In addition, some private insurance companies have agreements with pharmacies and so they offer discount for some medicines of 10% on average.