Cost‐effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO‐AD trial)
Year: 2016
Type: article
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.
DOI: 10.1002/gps.4583
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, Robert Jones, Cornelius Katona, James Lindesay, Ajay Macharouthu, Ian McKeith, Rupert McShane, John T O'Brien, Patrick P J Phillips, Bart Sheehan, Robert Howard
Institutions: London School of Economics and Political Science, King's College London, Brighton and Sussex Medical School, University of Sussex, Newcastle Hospitals - Campus for Ageing and Vitality, Birmingham and Solihull Mental Health NHS Foundation Trust, University of Manchester, University of Nottingham, Stratheden Hospital, University of Southampton, MRC Clinical Trials Unit at UCL, University College London, Medical Research Council, University of Leicester, NHS Ayrshire and Arran, University Hospital Crosshouse, Newcastle University, Oxford Health NHS Foundation Trust, Warneford Hospital, University of Cambridge, Oxford University Hospitals NHS Trust
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,120
Funders: Pfizer, South London and Maudsley NHS Foundation Trust, Alzheimer's Society, National Institute for Health and Care Research, King's College London, Eisai, H. Lundbeck A/S, School for Social Care Research, Medical Research Council, Menzies Centre for Australian Studies, King's College London, University of London
OpenAlex ID: W2513465760