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Bond M, Rogers G, Peters J, et al. The Effectiveness and Cost-Effectiveness of Donepezil, Galantamine, Rivastigmine and Memantine for the Treatment of Alzheimer's Disease (Review of Technology Appraisal No. 111): A Systematic Review and Economic Model. Southampton (UK): NIHR Evaluation, Trials and Studies Coordinating Centre (UK); 2012 Apr. (Health Technology Assessment, No. 16.21.)

Cover of The Effectiveness and Cost-Effectiveness of Donepezil, Galantamine, Rivastigmine and Memantine for the Treatment of Alzheimer's Disease (Review of Technology Appraisal No. 111): A Systematic Review and Economic Model

The Effectiveness and Cost-Effectiveness of Donepezil, Galantamine, Rivastigmine and Memantine for the Treatment of Alzheimer's Disease (Review of Technology Appraisal No. 111): A Systematic Review and Economic Model.

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2Definition of the decision problem

Decision problem

The inclusion criteria for this assessment are as follows.

Population

The population for this assessment is adults with AD. However, as in the assessment that informed TA No. 111 (TA111),1 where trials have included participants with mixed dementias, these trials will be included where the dominant dementia is AD. Papers will be considered on a case-by-case basis.

Intervention

The intervention to be included is dependent on the severity of AD, measured by the MMSE criteria:

Comparators

The comparators are again dependent on the severity of the AD:

  • Mild AD (MMSE 21–26) – placebo or best supportive care (BSC). (Best supportive care includes social support and assistance with day-to-day activities. These include information and education; carer support groups; community dementia teams; home nursing and personal care; community services, such as Meals on Wheels; befriending services; day centres, respite and care homes.)
  • Moderate AD (MMSE 10–20)donepezil, galantamine, rivastigmine, memantine, placebo or BSC.
  • Severe AD (MMSE < 10) – placebo or BSC.

Outcomes

The outcomes of interest include measures of:

  • severity of disease and response to treatment
  • behavioural symptoms
  • mortality
  • ability to remain independent
  • likelihood of admission to residential/nursing care
  • HRQoL of patients and carers (where data permit, analysis will be carried out separately for patients alone, and for patients and carers combined)
  • adverse effects of treatment
  • cost-effectiveness and costs (review of economic studies).

Key issues

All medicines will be considered according only to their UK marketing authorisation.

Overall aims and objectives of assessment

The purpose of this assessment was to review and update as necessary guidance to the NHS in England and Wales on the clinical effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine, within their UK licensed indications, for the treatment of AD, which was issued in November 2006, and amended in September 2001 and August 2009.

© 2012, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK98901
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