Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial).
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Authors
Knapp, Martin
King, Derek
Romeo, Renée
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
Phillips, Patrick PJ
Sheehan, Bart
Howard, Robert
Publication Date
2017-12Journal Title
Int J Geriatr Psychiatry
ISSN
0885-6230
Publisher
Wiley
Volume
32
Issue
12
Pages
1205-1216
Language
eng
Type
Article
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Knapp, M., King, D., Romeo, R., Adams, J., Baldwin, A., Ballard, C., Banerjee, S., et al. (2017). Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial).. Int J Geriatr Psychiatry, 32 (12), 1205-1216. https://doi.org/10.1002/gps.4583
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.
Keywords
Humans, Alzheimer Disease, Memantine, Piperidines, Indans, Cholinesterase Inhibitors, Activities of Daily Living, Double-Blind Method, Cognition, Quality of Life, Aged, Aged, 80 and over, Cost-Benefit Analysis, Health Care Costs, England, Wales, Female, Donepezil
Identifiers
External DOI: https://doi.org/10.1002/gps.4583
This record's URL: https://www.repository.cam.ac.uk/handle/1810/284952
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