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Randomized Controlled Trial
. 2017 Dec;32(12):1205-1216.
doi: 10.1002/gps.4583. Epub 2016 Oct 13.

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

Martin Knapp  1 , Derek King  1 , Renée Romeo  2 , Jessica Adams  3 , Ashley Baldwin  4 , Clive Ballard  5 , Sube Banerjee  6 , Robert Barber  7 , Peter Bentham  8 , Richard G Brown  9 , Alistair Burns  10 , Tom Dening  11 , David Findlay  12 , Clive Holmes  13 , Tony Johnson  14 , Robert Jones  11 , Cornelius Katona  15 , James Lindesay  16 , Ajay Macharouthu  17 , Ian McKeith  18 , Rupert McShane  19 , John T O'Brien  20 , Patrick P J Phillips  14 , Bart Sheehan  21 , Robert Howard  15
Affiliations
Randomized Controlled Trial

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

Martin Knapp et al. Int J Geriatr Psychiatry. 2017 Dec.

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.

Keywords: Alzheimer's disease; cost-effectiveness; donepezil; memantine.

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Figures

Figure 1
Figure 1
Cost‐effectiveness acceptability curve: donepezil continuation versus discontinuation; health and social care perspective, with effectiveness measured in QALYs. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Cost‐effectiveness acceptability curve: memantine versus memantine placebo; health and social care perspective, with effectiveness measured in QALYs. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Cost‐effectiveness acceptability curves: donepezil and memantine versus donepezil only; health and social care perspective, with effectiveness measured in QALYs, BADLS and MMSE. [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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