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Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial)

Authors

Martin Knapp

Derek King

Romeo

Jessica Adams

Ashley Baldwin

Clive Ballard

Sube Banerjee

Robert Barber

Peter Bentham

Richard G. Brown

Alistair Burns

TOM DENING Tom.Dening@nottingham.ac.uk
Clinical Professor in Dementia Research

David Findlay

Clive Holmes

Tony Johnson

Robert Jones

Cornelius Katona

James Lindesay

Ajay Macharouthu

Ian McKeith

Rupert McShane

John T. O'Brien

Patrick P. J. Phillips

Bart Sheehan

Robert Howard



Abstract

© 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. Objective: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients. Methods: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial. A total of 295 community-dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine. Results: Continuing donepezil for 52 weeks was more cost-effective than discontinuation, considering cognition, activities of daily living and health-related quality of life. Starting memantine was more cost-effective than donepezil discontinuation. Donepezil–memantine combined is not more cost-effective than donepezil alone. Conclusions: Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.

Citation

Knapp, M., King, D., Romeo, R., Adams, J., Baldwin, A., Ballard, C., …Howard, R. (2016). Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial). International Journal of Geriatric Psychiatry, 32(12), 1205-1216. https://doi.org/10.1002/gps.4583

Journal Article Type Article
Acceptance Date Aug 25, 2016
Online Publication Date Oct 13, 2016
Publication Date Oct 13, 2016
Deposit Date Nov 19, 2018
Publicly Available Date Nov 30, 2018
Journal International Journal of Geriatric Psychiatry
Print ISSN 0885-6230
Electronic ISSN 1099-1166
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 32
Issue 12
Pages 1205-1216
DOI https://doi.org/10.1002/gps.4583
Public URL https://nottingham-repository.worktribe.com/output/1214017
Publisher URL https://onlinelibrary.wiley.com/doi/full/10.1002/gps.4583

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