Donepezil, rivastigmine, galantamine and memantine for ...

List of abbreviations .................................. vii
Executive summary .................................... ix
1 Aim of the review ...................................... 1
2 Background ................................................ 3
Description of underlying health
problem ...................................................... 3
Prevalence and incidence ........................... 4
Current service provision ........................... 6
Description of the interventions considered
in this review .............................................. 8
3 Methods ..................................................... 9
Inclusion criteria ........................................ 9
Inclusion criteria and data extraction
process ........................................................ 9
Quality assessment ..................................... 9
Data synthesis ............................................. 11
Methods for the systematic review of
economic evaluations ................................. 11
4 Clinical effectiveness .................................. 13
Donepezil ................................................... 13
Rivastigmine ............................................... 40
Galantamine ............................................... 52
Head-to-head drug comparisons ............... 66
Memantine ................................................. 71
5 Evidence from systematic reviews ............ 79
Donepezil ................................................... 79
Rivastigmine ............................................... 79
Galantamine ............................................... 80
Memantine ................................................. 80
6 Economic analysis ...................................... 81
Introduction ............................................... 81
Cost-effectiveness: systematic review of the
literature ..................................................... 81
Economic evaluations of donepezil ........... 81
Economic evaluations of rivastigmine ....... 91
Economic evaluations of galantamine ....... 96
Summary of published systematic reviews
that offer a broader reporting on the costeffectiveness
of donepezil, rivastigmine
and galantamine ........................................ 102
Economic evaluations of memantine ......... 102
Costing considerations in the treatment of
AD ............................................................... 108
Contents
Health Technology Assessment 2006; Vol. 10: No. 1
Health state utilities/values for AD ............ 115
Mortality and AD ....................................... 116
Modelling AD progression over time ........ 117
SHTAC cost-effectiveness analysis for mild
to moderately severe AD ............................ 119
SHTAC cost-effectiveness analysis for
memantine for moderately severe to severe
AD ............................................................... 135
7 Research in progress ................................. 139
8 Implications for other parties .................... 141
9 Factors relevant to NHS policy ................. 143
10 Discussion and conclusions ........................ 145
Statement of principal findings ................. 145
Cost-effectiveness ....................................... 146
Other issues and methodological
concerns ..................................................... 147
Strengths and limitations of the
review .......................................................... 150
Implications for further research ............... 150
Acknowledgements .................................... 151
References .................................................. 153
Appendix 1 Diagnostic criteria ................. 161
Appendix 2 Research protocol .................. 165
Appendix 3 Search strategy ...................... 169
Appendix 4 Excluded studies .................... 171
Appendix 5 Quality assessment tool for
RCTs ........................................................... 177
Appendix 6 Severity rating scales and
outcome measures ...................................... 181
Appendix 7 Data extraction: donepezil
RCTs ........................................................... 187
Appendix 8 Data extraction: rivastigmine
RCTs ........................................................... 245
Appendix 9 Data extraction: galantamine
RCTs ........................................................... 259
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