Article
Cost-effectiveness of a dementia care management – Results of the cluster-randomized, controlled, interventional trial DelpHi-MV
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Authors
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Bernhard Michalowsky
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE) e.V., Versorgungsepidemiologie und Community Health, Greifswald
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Feng Xie
- McMaster University Hamilton, Department of Health Research Methods, Evidence and Impact, Hamilton, Canada
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Ingo Kilimann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Standort Rostock/Greifswald, Klinische Dermenzforschung, Rostock
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Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Standort Rostock/Greifswald, Klinische Dermenzforschung, Rostock
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René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Standort Rostock/Greifswald, Interventionelle Versorgungsforschung, Greifswald
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Diana Wucherer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Standort Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald
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Ina Zwingmann
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE) e.V., Translationale Versorgungsforschung, Greifswald
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Wolfgang Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Standort Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald
| Published: | October 12, 2018 |
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Outline
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Background: Dementia disease is associated with substantial health care costs. Since causal treatment is still out of sight, there is a considerable need for effective ways of care. Dementia care management can increase the quality of treatment and care for dementia. However, methodologically rigorous clinical trials on DCM are lacking and economic evaluations of care management programs have produced inconclusive evidence. The objective of this analysis is to conduct a cost-utility-analysis of dementia care management.
Methods: Analyses are based on 634 patients and baseline, follow up 1 and follow up 2 data of the DelpHi-MV study (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania), a general practitioner (GP)-based, cluster-randomized controlled intervention trial in a primary care setting. The main outcome after one year of the intervention of this trial was recently published demonstrating significant improvement in behavioral and psychological symptoms of dementia, quality of life, antidementia drug treatment and caregiver burden as compared to controls. For the cost-utility-analysis frequency of healthcare resource utilization was measured by using the Resource Utilization in Dementia questionnaire and health-related quality of life using the Short Form 12. Quality-adjusted life years were calculated using the area under the curve method and the subject based approach. Healthcare costs were assessed from the payer perspective as well as from societal perspective.
Results: 2 years after starting the trial, in the intervention group (dementia care management) adjusted total costs were lower (-1753€; SE 2405; IC95- -6467, IC95+2960; p=0.233) and significantly more Quality Adjusted Life years were gained (+0.11; SE 0.06; IC95- -0.004, IC95+0.22; p=0.029). The probability that the dementia care management was cost-effectiveness ranged between 60% and 95% at a willingness-to-pay-threshold of 0€/QALY and 40.000€/QALY, respectively. Results were robust for intention to treat, per protocol and complete case analyses.
Conclusion: Dementia Care Management could increase quality of life in dementia diseases and decrease health care cost. Therefore, an implementation into routine care could be beneficial for both patients and health care payers.
