Cost‐effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO‐AD trial) |
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| Authors: | Martin Knapp Derek King Renée Romeo Jessica Adams Ashley Baldwin Clive Ballard Sube Banerjee Robert Barber Peter Bentham Richard G Brown Alistair Burns Tom Dening David Findlay Clive Holmes Tony Johnson Cornelius Katona James Lindesay Ajay Macharouthu Ian McKeith Rupert McShane John T O'Brien Patrick P J Phillips Bart Sheehan Robert Howard |
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| Affiliation: | 1. Personal Social Services Research Unit, London School of Economics and Political Science, London, UK;2. King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;3. Department of Biostatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;4. Five Boroughs Partnership NHS Foundation Trust, Warrington, UK;5. Wolfson Centre for Age Related Disorders, King's College, London, London, UK;6. Brighton and Sussex Medical School, University of Sussex, Brighton, UK;7. Campus for Ageing and Vitality, Newcastle upon Tyne, UK;8. Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK;9. Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;10. Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK;11. Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK;12. Stratheden Hospital, Cupar, Scotland, UK;13. Faculty of Medicine, University of Southampton, Southampton, UK;14. Medical Research Council Clinical Trials Unit, University College London, London, UK;15. Division of Psychiatry, University College London, London, UK;16. Health Sciences, University of Leicester, Leicester, UK;17. Ayrshire and Arran NHS, University Hospital Crosshouse, Kilmarnock, UK;18. Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK;19. Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK;20. Department of Psychiatry, University of Cambridge, Cambridge, UK;21. Oxford University Hospitals NHS Foundation Trust, Oxford, UK |
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| 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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| Keywords: | Alzheimer's disease donepezil memantine cost‐effectiveness |
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