Alzheimer’s disease (AD) is the most common form of dementia and is characterised by a worsening of cognition, functional ability, and behaviour and mood. The objective of this study was to review the clinical and cost-effectiveness of memantine for the treatment of patients with moderately severe to severe AD. To achieve this, a systematic search and review of the clinical and cost effectiveness literature for memantine was undertaken. The literature search covered the period from the inception of MEDLINE, Cochrane Library, EMBASE and other electronic databases until July 2004. The search included randomised controlled trials (RCTs) and full economic evaluations that assessed the use of memantine in patients with moderately severe to severe AD.
Two published RCTs were included in this review; in one of these trials the participants were already being treated with donepezil. The two RCTs showed benefit for patients receiving memantine compared with placebo on the outcome measures of the Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory modified for severe dementia, the Clinician’s Interview-Based Impression of Change Plus Caregiver Input, and the Severe Impairment Battery, and that memantine appeared to be slightly more effective in patients already receiving a stable dose of donepezil. Five cost-effectiveness studies were included in the review. Although these studies reported cost reductions and improved outcomes with memantine, the evaluations were based on a number of assumptions.
In conclusion, memantine appears to be beneficial when assessed using functional and global measurements. However, the effect of memantine on cognitive scores and behaviour and mood outcomes is less clear. Cost-effectiveness is dependent upon assumptions surrounding clinical effect and context-specific cost data.
Memantine Rivastigmine Galantamine Transit Probability Personal Social Service
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
The study was completed as part of a review funded by the UK National Health Service Research and Development Health Technology Assessment Programme, and commissioned on behalf of the National Institute for Clinical Excellence. The view and opinions expressed are those of the authors and do not necessarily reflect those of the UK Department of Health.
The authors have no conflicts of interest that are directly relevant to the content of this study.
National Institute for Clinical Excellence Technology Appraisal Guidance: No 19. Guidance on the use of donepezil, rivastigmine and galantamine for the treatment of Alzheimer’s disease. London: NICE, 2001Google Scholar
Loveman E, Green C, Kirby J, et al. The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer’s disease. Health Technol Assess 2006; 10(1): 1–176 [online]. Available from URL: http://www.nchta.org [Accessed 2006 Mar 6]Google Scholar
Undertaking systematic reviews of research on effectiveness. York: Centre for Reviews and Dissemination; 2001 Mar. Report no.: 4Google Scholar
Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. New York: Oxford University Press, 1997Google Scholar
Reisberg B, Doody R, Stoffler A, et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med 2003; (348): 1333–41Google Scholar
Tariot PN, Farlow MR, Grossberg GT, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA 2004; 291(3): 317–24PubMedCrossRefGoogle Scholar
François C, Sintonen H, Sulkava R. The cost-effectiveness of memantine in moderately severe to severe Alzheimer’s disease: a Markov model in Finland. Clin Drug Invest 2004; 24(7): 373–84CrossRefGoogle Scholar
Jones R, McCrone P, Guilhaume C. Cost effectiveness of memantine in Alzheimer’s disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging 2004; 21(9): 607–20PubMedCrossRefGoogle Scholar
Guilhaume C. Cost effectiveness of memantine in the treatment of moderately severe and severe Alzheimer’s disease in Finland. Eur J Neurology 2003; 10Suppl. 1: 159–60Google Scholar
Launois R, Guilhame C, Francois C, et al. Cost effectiveness of memantine in the treatment of moderately severe and severe Alzheimer’s disease in Norway. International Conference on Alzheimer’s and Parkinson’s Diseases; 2003 May 8–12; SevilleGoogle Scholar
Antonanzas F, Badenas J, Francois C, et al. Cost effectiveness of memantine in the treatment of moderately severe and severe Alzheimer’s disease in Spain. Value Health 2003; 6(6): 765CrossRefGoogle Scholar
Winblad B, Poritis N. Memantine in severe dementia: results of the 9M-Best Study (benefit and efficacy in severely demented patients during treatment with memantine). Int J Geriatr Psychiatry 1999; 14(2): 135–46PubMedCrossRefGoogle Scholar
Jonsson L. Cost-effectiveness of memantine for moderate to severe Alzheimer’s disease in Sweden. Am J Geriatr Pharmacotherapy 2005; 3(2): 77–86CrossRefGoogle Scholar
Wimo A, Winblad B, Stoffler A, et al. Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer’s disease. Pharmacoeconomics 2003; 21(5): 327–40PubMedCrossRefGoogle Scholar
Tariot P, Federoff HJ. Current treatment for Alzheimer disease and future prospects. Alzheimer Dis Assoc Disord 2003; 17Suppl. 4: S105–13PubMedCrossRefGoogle Scholar
Kurz X, Scuvee-Moreau J, Rive B, et al. A new approach to the qualitative evaluation of functional disability in dementia. Int J Geriatr Psychiatry 2003; 18(11): 1050–5PubMedCrossRefGoogle Scholar
Mackell JA, Ferris SH, Mohs R, et al. Multicenter evaluation of new instruments for Alzheimer’s disease clinical trials: summary of results: the Alzheimer’s Disease Cooperative Study. Alzheimer Dis Assoc Disord 1997; 11Suppl. 2: S65–9PubMedCrossRefGoogle Scholar
Rahkonen T, Eloniemi-Sulkava U, Rissanen S, et al. Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older. J Neurol Neurosurg Psychiatry 2003; 74(6): 720–4PubMedCrossRefGoogle Scholar
Livingston G, Katona C, Roch B, et al. A dependency model for patients with Alzheimer’s disease: its validation and relationship to the costs of care — the LASER-AD Study. Curr Med Res Opin 2004; S7: 1007–16CrossRefGoogle Scholar
Philips Z, Ginnelly L, Sculpher M, et al. A review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004; 8(36): 1–179PubMedGoogle Scholar
Wolstenholme J, Fenn P, Gray A, et al. Estimating the relationship between disease progression and cost of care in dementia. Br J Psychiatry 2002; 181: 36–42PubMedCrossRefGoogle Scholar
Stewart A. Costs of care for people with dementia aged 75 and over: PSSRU. Canterbury: University of Kent; 1997 Mar. Report no.: Discussion paper 1303/2Google Scholar
Kavanagh S, Knapp M. Cognitive disability and direct care costs for elderly people. Br J Psychiatry 1999; 174: 539–46PubMedCrossRefGoogle Scholar
Kavanagh S, Schneider J, Knapp M, et al. Elderly people with dementia: cost effectiveness and balance of care. In: Knapp M, editor. The economic evaluation of mental health care. Aldershot: Arena, 1995: 125–56Google Scholar
Fenn P, Gray A. Estimating long term cost savings from treatment of Alzheimer’s disease: a modelling approach. Pharmacoeconomics 1999; 16(2): 165–74PubMedCrossRefGoogle Scholar
Netten A, Darton R, Bebbington A, et al. Residential and nursing home care of elderly people with cognitive impairment: prevalence, mortality and costs. Aging Ment Health 2001; 5(1): 14–22PubMedCrossRefGoogle Scholar
Kronborg AC, Sogaard J, Hansen E, et al. The cost of dementia in Denmark: the Odense Study. Dement Geriatr Cogn Disord 1999; 10(4): 295–304CrossRefGoogle Scholar
Andersen K, Nielsen H, Lolk A, et al. Incidence of very mild to severe dementia and Alzheimer’s disease in Denmark: the Odense Study. Neurology 1999; 52(1): 85–90PubMedCrossRefGoogle Scholar
Plosker GL, Lyseng-Williamson KA. Memantine: a pharmacoeconomic review of its use in moderate-to-severe Alzheimer’s disease. Pharmacoeconomics 2005; 23(2): 193–206PubMedCrossRefGoogle Scholar