Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial).
Brown, Richard G
O'Brien, John T
Phillips, Patrick PJ
Int J Geriatr Psychiatry
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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
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.
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
External DOI: https://doi.org/10.1002/gps.4583
This record's URL: https://www.repository.cam.ac.uk/handle/1810/284952
Attribution 4.0 International
Licence URL: https://creativecommons.org/licenses/by/4.0/