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Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial).
Int J Geriatr Psychiatry 2017; 32(12):1205-1216IJ

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.

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    Authors+Show Affiliations

    Knapp M
    Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
    King D
    Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
    Romeo R
    King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
    Adams J
    Department of Biostatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
    Baldwin A
    Five Boroughs Partnership NHS Foundation Trust, Warrington, UK.
    Ballard C
    Wolfson Centre for Age Related Disorders, King's College, London, London, UK.
    Banerjee S
    Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
    Barber R
    Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
    Bentham P
    Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
    Brown RG
    Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
    Burns A
    Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
    Dening T
    Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.
    Findlay D
    Stratheden Hospital, Cupar, Scotland, UK.
    Holmes C
    Faculty of Medicine, University of Southampton, Southampton, UK.
    Johnson T
    Medical Research Council Clinical Trials Unit, University College London, London, UK.
    Jones R
    Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.
    Katona C
    Division of Psychiatry, University College London, London, UK.
    Lindesay J
    Health Sciences, University of Leicester, Leicester, UK.
    Macharouthu A
    Ayrshire and Arran NHS, University Hospital Crosshouse, Kilmarnock, UK.
    McKeith I
    Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK.
    McShane R
    Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
    O'Brien JT
    Department of Psychiatry, University of Cambridge, Cambridge, UK.
    Phillips PPJ
    Medical Research Council Clinical Trials Unit, University College London, London, UK.
    Sheehan B
    Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
    Howard R
    Division of Psychiatry, University College London, London, UK.

    MeSH

    Activities of Daily LivingAgedAged, 80 and overAlzheimer DiseaseCholinesterase InhibitorsCognitionCost-Benefit AnalysisDonepezilDouble-Blind MethodEnglandFemaleHealth Care CostsHumansIndansMemantinePiperidinesQuality of LifeWales

    Pub Type(s)

    Journal Article
    Multicenter Study
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    27739182

    Citation

    Knapp, Martin, et al. "Cost-effectiveness of Donepezil and Memantine in Moderate to Severe Alzheimer's Disease (the DOMINO-AD Trial)." International Journal of Geriatric Psychiatry, vol. 32, no. 12, 2017, pp. 1205-1216.
    Knapp M, King D, Romeo R, et al. Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial). Int J Geriatr Psychiatry. 2017;32(12):1205-1216.
    Knapp, M., King, D., Romeo, R., Adams, J., Baldwin, A., Ballard, C., ... Howard, R. (2017). Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial). International Journal of Geriatric Psychiatry, 32(12), pp. 1205-1216. doi:10.1002/gps.4583.
    Knapp M, et al. Cost-effectiveness of Donepezil and Memantine in Moderate to Severe Alzheimer's Disease (the DOMINO-AD Trial). Int J Geriatr Psychiatry. 2017;32(12):1205-1216. PubMed PMID: 27739182.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial). AU - Knapp,Martin, AU - King,Derek, AU - Romeo,Renée, AU - Adams,Jessica, AU - Baldwin,Ashley, AU - Ballard,Clive, AU - Banerjee,Sube, AU - Barber,Robert, AU - Bentham,Peter, AU - Brown,Richard G, AU - Burns,Alistair, AU - Dening,Tom, AU - Findlay,David, AU - Holmes,Clive, AU - Johnson,Tony, AU - Jones,Robert, AU - Katona,Cornelius, AU - Lindesay,James, AU - Macharouthu,Ajay, AU - McKeith,Ian, AU - McShane,Rupert, AU - O'Brien,John T, AU - Phillips,Patrick P J, AU - Sheehan,Bart, AU - Howard,Robert, Y1 - 2016/10/13/ PY - 2016/05/19/received PY - 2016/08/25/revised PY - 2016/08/25/accepted PY - 2016/10/16/pubmed PY - 2018/6/21/medline PY - 2016/10/15/entrez KW - Alzheimer's disease KW - cost-effectiveness KW - donepezil KW - memantine SP - 1205 EP - 1216 JF - International journal of geriatric psychiatry JO - Int J Geriatr Psychiatry VL - 32 IS - 12 N2 - 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. SN - 1099-1166 UR - https://www.unboundmedicine.com/medline/citation/27739182/Cost_effectiveness_of_donepezil_and_memantine_in_moderate_to_severe_Alzheimer's_disease__the_DOMINO_AD_trial__ L2 - https://doi.org/10.1002/gps.4583 DB - PRIME DP - Unbound Medicine ER -