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

Knapp, Martin; King, Derek; Romeo, Ren�e; Adams, Jessica; Baldwin, Ashley; Ballard, Clive; Banerjee, Sube; Barber, Robert; Bentham, Peter; Brown, Richard G.; Burns, Alistair; Dening, Tom; Findlay, David; Holmes, Clive; Johnson, Tony; Jones, Robert; Katona, Cornelius; Lindesay, James; Macharouthu, Ajay; McKeith, Ian; McShane, Rupert; O'Brien, John T.; Phillips, Patrick P. J.; Sheehan, Bart; Howard, Robert

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