Cost-Effectiveness of One Year Dementia Follow-Up Care by Memory Clinics or General Practitioners: Economic Evaluation of a Randomised Controlled Trial

Els Meeuwsen,Geert Van Der Aa,René Melis,Frank Van Raak,Eddy Adang,Desiree Verheijen,Claire Wolfs,Marieke Visser,Carla Schölzel-Dorenbos,Marcel Olde Rikkert,Frans Verhey,Gertie Golüke-Willemse,Benoit De Leest

doi:10.1371/journal.pone.0079797

Abstract

ObjectiveTo evaluate the cost-effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared to general practitioners’ care.MethodsA multicentre randomised trial with 175 community dwelling patients newly diagnosed with mild to moderate dementia, and their informal caregivers, with twelve months’ follow-up. Cost-effectiveness was evaluated from a societal point of view and presented as incremental cost per quality adjusted life year. To establish cost-effectiveness, a cost-utility analysis was conducted using utilities based on the EQ-5D. Uncertainty surrounding the incremental cost-effectiveness ratio (difference in costs divided by difference in effects) was calculated by bootstrapping from the original data.ResultsCompared to general practitioners’ care, treatment by the memory clinics was on average €1024 (95% CI: −€7723 to €5674) cheaper, and showed a non-significant decrease of 0.025 (95% CI: −0.114 to 0.064) quality adjusted life years. The incremental cost-effectiveness point estimate from the bootstrap simulation was € 41 442 per QALY lost if one would use memory clinic care instead of general practitioner care.ConclusionNo evidence was found that memory clinics were more cost-effective compared to general practitioners with regard to post-diagnosis treatment and coordination of care of patients with dementia in the first year after diagnosis.Trial Registration ClinicalTrials.gov NCT00554047

Highlights

The quest for high quality, yet sustainable dementia care is becoming ever more challenging
Alongside the randomised trial of which the results of effectiveness were published recently [15], we examined if post-diagnosis treatment and coordination of care for patients with dementia and their caregivers by memory clinics is cost saving and more cost-effective compared to care provided by general practitioners
Most of the patients (60%, n = 105) had Alzheimer’s disease; in 84% (n = 147) of the patients, the severity of the dementia was very mild to mild

Summary

Introduction

The quest for high quality, yet sustainable dementia care is becoming ever more challenging. There is a strong trend towards early diagnosis in dementia, which may increase the period during which care for patients with dementia will be asked for [3]. These developments urge to answer the questions of how to optimise care for this population and how to ensure this care for future generations. Evidence about memory clinics being cost-effective in post-diagnosis treatment of dementia and follow-up care is scarce [13]. Knapp and colleagues reviewed the literature on economic evaluations of dementia care [14] They found that the majority of the economic evidence was on pharmacological interventions. The non-pharmacological interventions, on which they found little economic evidence was often of poor quality and harder to interpret

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Discussion

Conclusion