The cost of diagnosis and early support in patients with cognitive decline

Pennington, Mark; Gomes, Manuel; Chrysanthaki, Theti; Hendriks, Jolijn; Wittenberg, Raphael; Knapp, Martín; Black, Nick; Smith, Sarah C.

doi:10.1002/gps.4641

Cited by 10 publications

(15 citation statements)

References 27 publications

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“…Full details of the resource use and costing approach are reported elsewhere (16). Briefly, total MAS costs included diagnostic services, and half (6 months) of the annual MAS costs with interventions and follow up care.…”

Section: Resource Use and Costsmentioning

confidence: 99%

Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

Gomes

Pennington

Wittenberg

et al. 2017

J Health Serv Res Policy

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BackgroundPolicy makers in England advocate referral of patients with suspected dementia to Memory Assessment Services (MAS) but it is unclear how any improvement in patients' health-related quality of life (HRQL) compares with the associated costs. AimsTo evaluate the cost-effectiveness of MAS for the diagnosis and follow-up care of patients with suspected dementia. MethodWe analysed observational data from 1318 patients referred to 69 MAS, and their lay carers (n=944), who completed resource use and HRQL questionnaires at baseline, three and six months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3L), quality-adjusted life years (QALYs) and costs between baseline and 6 months of referral to MAS. We also assessed cost-effectiveness of MAS across different patient subgroups and clinic characteristics. ResultsReferral to MAS was associated with gains in DEMQOL (mean gain 3.48, 95% confidence interval: 2.84 to 4.12), EQ-5D-3L (0.023, 0.008 to 0.038) and QALYs (0.006, 0.002 to 0.01).Mean total costs over six months, assuming a societal perspective, was £1,899 (£1277 to £2539). This yielded a negative incremental net monetary benefit, -£1724 (-£2388 to -£1085) assuming NICE's recommended willingness-to-pay threshold (£30,000 per QALY). These base case results were relatively robust to alternative assumptions about costs and HRQL.There was some evidence that patients aged 80 or older benefitted more from referral to MAS (p<0.01 from adjusted mean differences in net benefits) compared to younger patients. MAS with over 75 new patients a month or cost per patient less than £2500 were relatively more cost-effective (p < 0.01) than MAS with fewer new montly patients or higher cost per patient, respectively. ConclusionsDiagnosis, treatment and follow-up care provided by MAS to patients with suspected dementia appears to be effective, but not cost-effective over the first six months after diagnosis. Longer-term evidence is required before drawing conclusions about the costeffectiveness of MAS.

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Section: Resource Use and Costsmentioning

confidence: 99%

Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

Gomes

Pennington

Wittenberg

et al. 2017

J Health Serv Res Policy

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“…We conducted a longitudinal study that followed up 1318 patients referred to 69 MAS in England . In previous papers, we reported HRQL, costs, and cost‐effectiveness between first assessment and 6 months. The studies reported that MAS improved patient's HRQL, according to both disease‐specific and generic HRQL instruments, irrespective of the severity of peoples' cognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

“…The studies reported that MAS improved patient's HRQL, according to both disease‐specific and generic HRQL instruments, irrespective of the severity of peoples' cognitive impairment. While there was little variation in outcome between MAS, there was considerable variation in costs and cost‐effectiveness . However, the sustainability of such changes over a longer time period is unknown.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness analysis of English memory assessment services 2 years after first consultation for patients with dementia

Gomes

Pennington

Black

et al. 2018

Int J Geriat Psychiatry

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Objectives: This paper aims to compare changes over 2 years in patients' healthrelated quality of life (HRQL) with the health and social care costs of diagnosis and treatment of people newly referred to memory assessment services (MAS). Methods:We analysed observational data from 1318 patients referred to 69 MAS who completed resource use and HRQL questionnaires at baseline 3, 6, 12, and 24 months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3 L), quality-adjusted life years (QALYs), costs and costeffectiveness between baseline, and 2-year follow-up.Results: Two years after referral to MAS, patients reported a higher DEMQOL score (mean gain 4.47, 95% confidence interval, 3.08-5.90) and EQ-5D-3 L (0.014, −0.011 to 0.039). Mean total costs and QALYs over 24 months was £2411 (£1721-£2873) and 0.027 (0.003-0.051), respectively. Assuming that patients' HRQL would not have altered over the 2 years had they not attended MAS, these outcomes suggest an incremental cost-effectiveness ratio of £89 546 (£38 123-£145 864) based on changes in EQ-5D-3 L. If we assumed that patients' HRQL would have declined by about 10% over this period had they not attended MAS, the cost-effectiveness ratio would be £25 056. The largest MAS (N = 32; 46%) with over 50 new patients a month were more likely to be cost-effective than smaller ones (P < 0.01).Conclusions: MAS are effective and can be cost-effective for diagnosing and treating people with suspected dementia. Large variations in costs between clinics suggest that many MAS could improve their cost-effectiveness. KEYWORDS cost-effectiveness analysis, dementia, England, memory assessment services 1 | INTRODUCTION The number of people living with dementia worldwide has increased in the last two decades mainly driven by population ageing. 1 In 2017, there were an estimated 50 million people with dementia, with nearly 10 million new cases expected now every year. 1 Dementia is a major cause of disability and burden of care in elderly people and is associated with rising health care costs. The costs associated with dementia worldwide are expected to rise above $1 trillion in 2018, which represents over 1% of the global GDP. 2 These rising costs are mostly due to the increased need for social and health care and family support (informal care). 2There is considerable evidence that early diagnosis and support for those with dementia enables them to live well for longer and helps reduce long-term costs. 3,4 To encourage this, referral of people with

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“…A survey of a large random sample of MASs in England conducted in 2015 (Chrysanthaki et al, ) revealed considerable variation in both their structural characteristics (such as staffing levels, skill mix and provision of post‐diagnostic support) and their processes (such as waiting times, length of appointments and frequency of follow‐up). Given the wide differences in costs per patient that result from such variation (Pennington et al, in press), it is important to know if such characteristics are associated with patient outcomes (Figure ).…”

Section: Introductionmentioning

confidence: 99%

Is the effectiveness of memory assessment services associated with their structural and process characteristics?

Park

Black

Ritchie

et al. 2017

Int J Geriat Psychiatry

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Key points: No previous study has looked at the characteristics of memory assessment services (MASs) in relation to patient or carer outcomes. In a large study of 785 patients attending 69 services, we show that most structural and process characteristics of MASs are not associated with patients' health-related quality of life (HRQL), carers' HRQL or carers' burden. The only exception is the involvement of allied health professionals such as occupational therapists, which is associated with better patient HRQL. The sponsor had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the report for publication. Word count of body text: 2978 MethodsData from 785 patients referred to 69 MASs and 511 of their lay carers, collected at the first appointment and six months later. Data on MAS characteristics collected using a questionnaire at baseline. We used multilevel linear regression models to explore the associations of patients' HRQL and carers' outcomes with structural and process characteristics of MASs. Analyses were conducted on the full sample of patients and carers, and separately on those patients diagnosed with dementia. ResultsNone of the structural (skill mix, workload, volume, provision of clinical assessments, provision of psychosocial support) or process (waiting time, length and number of appointments, anti-dementia drug use, psychosocial interventions use) characteristics included in the analyses were associated with patients' or carers' outcomes at 6 months, apart from the presence of allied health professionals (AHPs), which was associated with a DEMQOL score 2.7 points higher. When only those with a diagnosis of dementia were considered, the association with presence of AHPs was no longer observed. Conclusions 5Apart from involving AHPs, alterations to the way memory assessment services are structured or function appear unlikely to improve their effectiveness in improving patients' and carers' HRQL. It is possible that the characteristics of MASs may influence patients' and carers' experience but this was not studied.6

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The cost of diagnosis and early support in patients with cognitive decline

Cited by 10 publications

References 27 publications

Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

Cost‐effectiveness analysis of English memory assessment services 2 years after first consultation for patients with dementia

Is the effectiveness of memory assessment services associated with their structural and process characteristics?

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