In Germany, around one million people suffer from dementia, around 700,000 of them from Alzheimer's disease. According to official estimates, this number will have doubled in 20 to 30 years. However, the market for anti-Alzheimer preparations is already experiencing significant growth.

>> The supply of anti-Alzheimer drugs has developed positively in Germany in recent years. Even if it is not possible to cure Alzheimer's dementia according to the current state of medicine, there are still a few drugs available that help to delay the decline in cognitive performance (cf. e.g. IQWiG 2007: Cholinesterase inhibitors in Alzheimer's Dementia). Nevertheless, the judgment of the IQWiG with regard to the benefit of drug therapies is not unreservedly positive, as can also be seen from the discussion about the final report on "Memantine in Alzheimer's Dementia" published on September 10, 2009.
There are increasing sales figures for anti-Alzheimer preparations. In 2008, over 1.5 million packs of anti-Alzheimer's drugs (ATC code according to EphMRA: N07D "anti-Alzheimer's preparations"; e.g. excluding gingko biloba) were distributed to pharmacies via pharmaceutical wholesalers (cf. Fig. 1).
This corresponds to an increase of almost 11 percent compared to 2007. Based on pharmacy sales prices (AVP), the sold quantity corresponds to a turnover of 316 million euros in 2008.
In addition to the active ingredient memantine, cholinesterase inhibitors (donepezil, galantamine and rivastigmine) are used in particular to treat dementia. According to current analyzes by INSIGHT Health, these make up around 60 percent of the pharmacy purchases of anti-Alzheimer preparations (see Fig. 2) and are the main drivers of the increase with 13.3 percent growth compared to the previous year.
Regional particularities
There are clear differences in drug sales resp. –Expenditure on anti-Alzheimer preparations between the federal states. While the city states of Bremen, Hamburg and Berlin had the lowest per capita expenditures for anti-Alzheimer drugs, these expenditures are sometimes noticeably higher in the new federal states. The per capita expenditure (according to AVP) within these regulations is just under one euro per year in Bremen. The comparative value in Saxony is 6.11 euros, more than six times as much. The national average is 3.68 euros. (see Fig. 3)
Age as a risk factor

Age is an essential correlate of Alzheimer's disease. This is also reflected in the figures for Alzheimer's disease. As current analyzes by INSIGHT Health show, more than 97 percent of anti-Alzheimer's preparations are prescribed to patients who are older than 60 years (see Fig. 3).
Around seven percent of people over the age of 65 are currently affected by Alzheimer's dementia. Prevalence and incidence figures increase with advancing age (cf. German Alzheimer Society: Self-help Dementia, p.1). Increasing life expectancy will lead to a further increase in the number of illnesses in the future.
One possible explanation for the regional differences outlined above is the age of the population. In many regions of the new federal states, the average age is significantly higher. While the statistical average age of Germans was 42.9 years in 2007, this value is 2.5 years higher for Saxony and Saxony-Anhalt (cf. Monthly Statistical Bulletin Baden-Württemberg 12/2008, p.1). Further analyzes should now examine the extent to which there are also differences in the level of care in the federal states. For example, it is also noticeable that in the statutory health insurance market in Berlin, memantine accounts for only 23.6 percent of expenditure on anti-Alzheimer preparations, but in Bremen it accounts for 38.2 percent (according to RVI, INSIGHT Health).
Alzheimer's dementia is more common in women than in men in all age groups (cf. Schmidt et al.: Gender-specific differences in Alzheimer's dementia; in: Neuropsychiatrie, Volume 22, No. 1/2008, pp. 1-15), which can also be determined on the part of the drug supply. Around 65 percent of anti-Alzheimer's preparations are prescribed to women - regardless of the active ingredient group (according to patient tracking, INSIGHT Health).
The increased numbers are associated with longer life expectancies for women. For example, the life expectancy for newborn girls at 82.4 years is around 5.2 years above the comparative value for newborn boys (cf. press release no. 364 of the Federal Statistical Office of September 24, 2009: "Life expectancy in Germany continues to rise"). <<
by: Christian Bensing /
Dr. André Kleinfeld*