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

Abstract

ObjectiveMost 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.MethodsCost‐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.ResultsContinuing 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.ConclusionsRobust 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.

Economics and mental health: the current scenario

“…For people with moderate‐to‐severe AD, a recently published trial offered new economic evidence. The cost‐effectiveness of donepezil continuation compared to discontinuation was demonstrated when looking at each of a number of outcomes – cognition, functioning (activities of daily living), and QALYs – and whether costs measured only health and social care service use or additionally unpaid care. It also reduced the risk of nursing home placement after 1 year (but not 4 years).…”

Measurement tools of resource use and quality of life in clinical trials for dementia or cognitive impairment interventions: A systematically conducted narrative review

“…A Likert scale measures attitudes and behaviours using answer choices that range from one extreme to another and thus allows the respondent to uncover degrees of opinion. In the eligible studies, DEMQOL and DEMQOL‐Proxy were used together with the exception of DEMQOL‐Proxy for people with moderate to severe dementia . Score ranges from 28 to 112 for DEMQOL and 31 to 124 for DEMQOL‐Proxy.…”

“…There were 5 studies using adapted CSRI to collect resource use data. [15][16][17][18][19][20][21] All studies were conducted in the UK, ranging from mild to severe dementia. The CSRI was developed by Knapp and Beecham in the mid-1980s to collect detailed information on health care services received, medication, and wider carer economic impacts.…”

Enhancing NMDA Receptor Function: Recent Progress on Allosteric Modulators

“…Memantine is a NMDAR blocker and is thought to be neuroprotective by blocking excitotoxicity. It can be used for the treatment of moderate to severe AD, and recent studies demonstrated that memantine shows benefits in improving cognition, behavior, and daily living in AD patients [47, 48]. …”