What are the current and projected future cost and health-related quality of life implications of scaling up cognitive stimulation therapy?

Adelina Comas‐Herrera,Annette Bauer,Gloria Wong,Anita Patel,Aimee Spector,Audrey Wessel,Eva Cyhlarova,Andrew Kingston,Raphael Wittenberg,Martin Knapp,Bo Hu,Carol Jagger

doi:10.1002/gps.5633

Abstract

Cognitive stimulation therapy (CST) is one of the few non-pharmacological interventions for people living with dementia shown to be effective and cost-effective. What are the current and future cost and health-related quality of life implications of scaling-up CST to eligible new cases of dementia in England? Data from trials were combined with microsimulation and macrosimulation modelling to project future prevalence, needs and costs. Health and social costs, unpaid care costs and quality-adjusted life years (QALYs) were compared with and without scaling-up of CST and follow-on maintenance CST (MCST). Scaling-up group CST requires year-on-year increases in expenditure (mainly on staff), but these would be partially offset by reductions in health and care costs. Unpaid care costs would increase. Scaling-up MCST would also require additional expenditure, but without generating savings elsewhere. There would be improvements in general cognitive functioning and health-related quality of life, summarised in terms of QALY gains. Cost per QALY for CST alone would increase from £12,596 in 2015 to £19,573 by 2040, which is below the threshold for cost-effectiveness used by the National Institute for Health and Care Excellence (NICE). Cost per QALY for CST and MCST combined would grow from £19,883 in 2015 to £30,906 by 2040, making it less likely to be recommended by NICE on cost-effectiveness grounds. Scaling-up CST England for people with incident dementia can improve lives in an affordable, cost-effective manner. Adding MCST also improves health-related quality of life, but the economic evidence is less compelling.

Highlights

Responses to dementia are of three kinds: upstream prevention, efforts to find disease‐modifying treatments, and better care and support
This paper reports the cost and health‐related quality of life implications of scaling‐up cognitive stimulation therapy to eligible people with dementia in England over a 25 year period
The higher costs of scaling‐up Cognitive stimulation therapy (CST) to the full eligible population over a 25 year period would be considered worth paying by reference to criteria used by the National Institute for Health and Care Excellence (NICE) in England

Summary

Key points

There are few evidence‐based non‐pharmacological interventions for people living with dementia. Cognitive stimulation therapy (CST) is both effective and cost‐effective, but current availability is constrained. Scaling‐up CST would improve general cognitive functioning and health‐related quality of life, and increase costs for health and social care services, and for family and other unpaid carers. Adding maintenance CST would improve health‐related quality of life, with even greater cost increases. The higher costs of scaling‐up CST to the full eligible population over a 25 year period would be considered worth paying by reference to criteria used by the National Institute for Health and Care Excellence (NICE) in England. The economic evidence for adding maintenance CST is less compelling

| INTRODUCTION

| MATERIALS AND METHODS

| RESULTS

| DISCUSSION

Findings

| CONCLUSIONS