Knapp, Martin, King, Derek, Romeo, Renée, Adams, Jessica, Baldwin, Ashley, Ballard, Clive, Banerjee, Sube, Barber, Robert, Bentham, Peter, Brown, Richard G, Burns, Alistair, Dening, Tom, Findlay, David, Holmes, Clive, Johnson, Tony, Jones, Robert, Katona, Cornelius, Lindesay, James, Macharouthu, Ajay, McKeith, Ian, McShane, Rupert, O'Brien, John T, Phillips, Patrick P J, 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, 32 (12). (doi: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.
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