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

Knapp, Martin and King, Derek and Romeo, Renée and Adams, Jessica and Baldwin, Ashley and Ballard, Clive and Banerjee, Sube and Barber, Robert and Bentham, Peter and Brown, Richard G. and Burns, Alistair and Dening, Tom and Findlay, David and Holmes, Clive and Johnson, Tony and Jones, Robert and Katonal, Cornelius and Lindesay, James and Macharouthu, Ajay and McKeith, Ian and McShane, Rupert and O'Brien, John T. and Phillips, Patrick P. J. and Sheehan, Bart and Howard, Robert (2016) Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer’s disease (the DOMINO-AD trial). International Journal of Geriatric Psychiatry. ISSN 0885-6230

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Identification Number: 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.

Item Type: Article
Official URL: http://onlinelibrary.wiley.com/journal/10.1002/(IS...
Additional Information: © 2016 The Authors © CC BY 4.0
Subjects: R Medicine > RA Public aspects of medicine
Sets: Research centres and groups > Personal Social Services Research Unit (PSSRU)
Date Deposited: 06 Sep 2016 15:34
Last Modified: 05 Sep 2017 09:10
Projects: G0600989
Funders: National Institute for Health Research, South London and Maudsley NHS Foundation Trust, King's College London, Medical Research Council
URI: http://eprints.lse.ac.uk/id/eprint/67601

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