Adams J

Baldwin A

Ballard C

Banerjee S

Barber R

Bentham P

Brown RG

Burns A

Dening T

Findlay D

Holmes C

Howard R

Johnson T

Jones R

Katona C

King D

Knapp M

Lindesay J

Macharouthu A

McKeith I

McShane R

O'Brien JT

Phillips PPJ

Romeo R

Sheehan B

\ua9 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley &amp; Sons Ltd.Objective: Most investigations of pharmacotherapy for treating Alzheimer\u27s 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\u27s 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\u27s 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 52weeks 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\u27 lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer\u27s disease, such as those issued by NICE in England and Wales, should be revisited

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Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer\u27s disease (the DOMINO-AD trial)

https://eprint.ncl.ac.uk/fulltext.aspx?url=236534/2322AC2D-0764-42E6-83AE-C9509CD7F1FB.pdf&pub_id=236534

Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer\u27s disease (the DOMINO-AD trial)

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