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Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial).
Authors
Jessica Adams
Ashley Baldwin
+23 more
Clive Ballard
Sube Banerjee
Robert Barber
Peter Bentham
Richard G Brown
Alistair Burns
Tom Dening
David Findlay
Clive Holmes
Robert Howard
Tony Johnson
Robert Jones
Cornelius Katona
Derek King
Martin Knapp
James Lindesay
Ajay Macharouthu
Ian McKeith
Rupert McShane
John T O'Brien
Patrick PJ Phillips
Renée Romeo
Bart Sheehan
Publication date
13 October 2016
Publisher
Int J Geriatr Psychiatry
Doi
Cite
Abstract
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
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