Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial).

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.

• 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
• Journal: International journal of geriatric psychiatry (Int J Geriatr Psychiatry) Vol. 32 Issue 12 Pg. 1205-1216 (12 2017) ISSN: 1099-1166 [Electronic] England
• PMID: 27739182 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.

Chemical References

• Cholinesterase Inhibitors
• Indans
• Piperidines
• Donepezil
• Memantine

Topics

• Activities of Daily Living
• Aged
• Aged, 80 and over
• Alzheimer Disease (drug therapy, economics)
• Cholinesterase Inhibitors (economics, therapeutic use)
• Cognition
• Cost-Benefit Analysis
• Donepezil
• Double-Blind Method
• England
• Female
• Health Care Costs
• Humans
• Indans (economics, therapeutic use)
• Memantine (economics, therapeutic use)
• Piperidines (economics, therapeutic use)
• Quality of Life
• Wales