Abstract
BackgroundA community-based occupational therapy intervention for people with mild to moderate dementia and their family carers: the Community Occupational Therapy in Dementia–UK version (COTiD-UK); and Treatment as usual (TAU) were randomly assigned to 468 pairs (each comprising a person with dementia and a family carer) in the Valuing Active Life in Dementia (VALID) randomised controlled trial (RCT).ObjectivesTo compare the cost-utility of the COTiD-UK intervention compared to TAU, using data from the VALID RCT.MethodsWe performed a cost-utility analysis estimating mean costs and quality adjusted life years (QALYs) per person with dementia and carer for both treatments over a 26 weeks’ time horizon based on resource use data and utility values collected in the trial.ResultsTaking the National Health Service and Personal Social Services perspective, including costs and benefits to the person with dementia only, measuring Health Related Quality of Life based on Dementia Quality of Life scale (DEMQOL), accounting for missing data and adjusting for baseline values, there was a significant difference in costs between COTiD-UK and TAU (mean incremental cost for COTiD-UK £784 (95% CI £233 to £1334)), but no significant difference in outcomes (mean QALYs gained 0.00664 (95% CI -0.00404, 0.01732)). The Incremental Net Monetary Benefit (INMB) for COTiD-UK versus TAU was negative at a maximum willingness to pay for a QALY of £20000 (mean -£651, 95% CI -£878 to -£424) or £30000 (mean -£585, 95% CI -£824 to -£345). Extensive sensitivity analyses confirmed the results.ConclusionsThis community-based occupational therapy intervention has a very low probability of being cost-effective.
Highlights
In the UK around 850,000 people live with dementia [1], mostly in the community
The UK version of the intervention, Community Occupational Therapy in Dementia (COTiD)-UK has been recently evaluated in the Valuing Active Life in Dementia (VALID) randomised controlled trial (RCT) [10]
Carers had to: be aged 18 or over; and provide practical support with domestic or personal activities to the person with dementia for at least four hours per week. Both parties had to: be able to converse in English; be willing to participate in the COTiD-UK intervention together if allocated to receive it; and have the capacity to provide consent
Summary
In the UK around 850,000 people live with dementia [1], mostly in the community. By 2040, there will be over 1.2million people living with dementia in England and Wales [2], largely due to increased life expectancy and an increased proportion of older people in the population. A community-based occupational therapy intervention for people with mild to moderate dementia and their family carers–the Community Occupational Therapy in Dementia (COTiD)—was found to be clinically and cost effective in the Netherlands [6,7,8], but not in Germany [9]. The UK version of the intervention, COTiD-UK has been recently evaluated in the Valuing Active Life in Dementia (VALID) randomised controlled trial (RCT) [10]. A community-based occupational therapy intervention for people with mild to moderate dementia and their family carers: the Community Occupational Therapy in Dementia–UK version (COTiD-UK); and Treatment as usual (TAU) were randomly assigned to 468 pairs (each comprising a person with dementia and a family carer) in the Valuing Active Life in Dementia (VALID) randomised controlled trial (RCT)
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