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

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

doi:10.1002/gps.4583

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

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

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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.

Original language	English
Journal	International Journal of Geriatric Psychiatry
Early online date	13 Oct 2016
DOIs	https://doi.org/10.1002/gps.4583
Publication status	E-pub ahead of print - 13 Oct 2016

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Cost-effectiveness of_KNAPP_Accepted25August2016_GOLD VoRFinal published version, 432 KBLicence: CC BY

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Knapp, M., King, D., Romeo, R., Adams, J., Baldwin, A., Ballard, C., Banerjee, S., Barber, R., Bentham, P., Brown, R. G., Burns, A., Dening, T., Findlay, D., Holmes, C., Johnson, T., Jones, R., Katona, C., Lindesay, J., Macharouthu, A., ... Howard, R. (2016). Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial). International Journal of Geriatric Psychiatry. Advance online publication. https://doi.org/10.1002/gps.4583

@article{06b17f08923c4755a55e171ec2485476,

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

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. {\textcopyright} 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.",

author = "Martin Knapp and Derek King and Ren{\'e}e Romeo and Jessica Adams and Ashley Baldwin and Clive Ballard and Sube Banerjee and Robert Barber and Peter Bentham and Brown, {Richard G} and Alistair Burns and Tom Dening and David Findlay and Clive Holmes and Tony Johnson and Robert Jones and Cornelius Katona and James Lindesay and Ajay Macharouthu and Ian McKeith and Rupert McShane and O'Brien, {John T} and Phillips, {Patrick P J} and Bart Sheehan and Robert Howard",

note = "{\textcopyright} 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.",

year = "2016",

month = oct,

day = "13",

doi = "10.1002/gps.4583",

language = "English",

journal = "International Journal of Geriatric Psychiatry",

issn = "0885-6230",

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Knapp, M, King, D, Romeo, R, Adams, J, Baldwin, A, Ballard, C, Banerjee, S, Barber, R, Bentham, P, Brown, RG, Burns, A, Dening, T, Findlay, D, Holmes, C, Johnson, T, Jones, R, Katona, C, Lindesay, J, Macharouthu, A, McKeith, I, McShane, R, O'Brien, JT, Phillips, PPJ, Sheehan, B & Howard, R 2016, 'Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial)', International Journal of Geriatric Psychiatry. https://doi.org/10.1002/gps.4583

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

PY - 2016/10/13

Y1 - 2016/10/13

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.

AB - 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.

U2 - 10.1002/gps.4583

DO - 10.1002/gps.4583

M3 - Article

C2 - 27739182

SN - 0885-6230

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

ER -

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

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