title: Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial).
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: King
authors.affiliation: King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Renée
authors.initials: R
authors.lastname: Romeo
authors.affiliation: Department of Biostatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Adams
authors.affiliation: Five Boroughs Partnership NHS Foundation Trust, Warrington, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Baldwin
authors.affiliation: Wolfson Centre for Age Related Disorders, King's College, London, London, UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
authors.affiliation: Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
authors.forename: Sube
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Barber
authors.affiliation: Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bentham
authors.affiliation: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Brown
authors.affiliation: Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Alistair
authors.initials: A
authors.lastname: Burns
authors.affiliation: Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Dening
authors.affiliation: Stratheden Hospital, Cupar, Scotland, UK.
authors.forename: David
authors.initials: D
authors.lastname: Findlay
authors.affiliation: Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Holmes
authors.affiliation: Medical Research Council Clinical Trials Unit, University College London, London, UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Johnson
authors.affiliation: Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Jones
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Katona
authors.affiliation: Health Sciences, University of Leicester, Leicester, UK.
authors.forename: James
authors.initials: J
authors.lastname: Lindesay
authors.affiliation: Ayrshire and Arran NHS, University Hospital Crosshouse, Kilmarnock, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Macharouthu
authors.affiliation: Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: McKeith
authors.affiliation: Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
authors.forename: Rupert
authors.initials: R
authors.lastname: McShane
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: John T
authors.initials: JT
authors.lastname: O'Brien
authors.affiliation: Medical Research Council Clinical Trials Unit, University College London, London, UK.
authors.forename: Patrick P J
authors.initials: PPJ
authors.lastname: Phillips
authors.affiliation: Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: Bart
authors.initials: B
authors.lastname: Sheehan
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Howard
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000191:economics; D002800:Cholinesterase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D003071:Cognition; D003362:Cost-Benefit Analysis; D000077265:Donepezil; D004311:Double-Blind Method; D004739:England; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007189:Indans / Q000191:economics / Q000627:therapeutic use*; D008559:Memantine / Q000191:economics / Q000627:therapeutic use*; D010880:Piperidines / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D014852:Wales
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil; D008559:Memantine
keywords: Alzheimer's disease; cost-effectiveness; donepezil; memantine