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

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

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.

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

Record 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.

Text
Knapp_et_al-2017-International_Journal_of_Geriatric_Psychiatry - Version of Record
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More information

Accepted/In Press date: 25 August 2016
e-pub ahead of print date: 13 October 2016
Additional Information: © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
Keywords: Journal Article

Identifiers

Local EPrints ID: 416063
URI: https://eprints.soton.ac.uk/id/eprint/416063
PURE UUID: 13041872-a7ab-4e63-b102-c3ac719c58ef
ORCID for Richard G Brown: ORCID iD orcid.org/0000-0003-0156-7087
ORCID for Clive Holmes: ORCID iD orcid.org/0000-0003-1999-6912

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Date deposited: 01 Dec 2017 17:30
Last modified: 10 Dec 2019 01:53

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Contributors

Author: Martin Knapp
Author: Derek King
Author: Renée Romeo
Author: Jessica Adams
Author: Ashley Baldwin
Author: Clive Ballard
Author: Sube Banerjee
Author: Robert Barber
Author: Peter Bentham
Author: Richard G Brown ORCID iD
Author: Alistair Burns
Author: Tom Dening
Author: David Findlay
Author: Clive Holmes ORCID iD
Author: Tony Johnson
Author: Robert Jones
Author: Cornelius Katona
Author: James Lindesay
Author: Ajay Macharouthu
Author: Ian McKeith
Author: Rupert McShane
Author: John T O'Brien
Author: Patrick P J Phillips
Author: Bart Sheehan
Author: Robert Howard

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