PMH15 COST-EFFECTIVENESS OF THE MANAGING AGITATION AND RAISING QUALITY OF LIFE IN DEMENTIA (MARQUE) INTERVENTION FOR AGITATION SYMPTOMS IN PEOPLE WITH DEMENTIA IN CARE HOMES

Abstract

Many people with dementia in care homes have distressing and costly agitation symptoms. This study assessed whether the MARQUE (Managing Agitation and Raising QUality of LifE) intervention was cost-effective (as measured with quality adjusted life years (QALYs)) compared to treatment as usual (TAU). This study was an eight-month cluster-randomised controlled trial that enrolled 404 residents (MARQUE=189; TAU=215) living in care homes. Data on healthcare service use and prescriptions were collected at baseline and 8 months asking about the previous 4 months. QALYs were calculated using the EQ-5D-5L adjusting for baseline differences over 8 months between groups. We used multivariate imputation by chained equation for missing data, generating 20 imputed data sets. For each data set we ran 1,000 bootstrap replications using non-parametric bootstrapping; results were combined to calculate the mean values for costs and utilities and the standard errors around the imputed values, used to calculate 95%CI around point estimates. Mean total cost per resident in the MARQUE group, including the cost of the intervention, was £1,379 (95%CI £1,041 to £1,718), compared with £1,175 (95%CI £917 to £1,433) in the TAU group, generating a mean difference of £204 (95%CI -£215 to £623; p-value=0.320). Non-parametric bootstrapping after multiple imputation produced 0.346 (95%CI 0.330 to 0.362) QALYs in the MARQUE group and 0.332 (95%CI 0.322 to 0.342) QALYs in the TAU group, generating a mean difference of 0.015 QALYs (95%CI -0.004 to 0.034; p-value=0.127). Combining the difference in costs and difference in QALYs, the mean incremental cost per QALY gained of the MARQUE compared to TAU was £14,064. This study showed that although the mean incremental cost per QALY gained is below the NICE threshold, it has a low probability (62%) of being cost-effective at a willingness-to-pay of £20,000 per QALY due to the wide confidence intervals for costs and QALYs.