Cost-Effectiveness of Dementia Care Mapping in Care-Home Settings: Evaluation of a Randomised Controlled Trial

Abstract

Background Behaviours such as agitation impact on the quality of life of care-home residents with dementia and increase healthcare use. Interventions to prevent these behaviours have little evidence supporting their effectiveness or cost-effectiveness. We conducted an economic evaluation alongside a trial assessing Dementia Care Mapping™ (DCM) versus usual care for reducing agitation, and highlight methodological challenges of conducting evaluations in this population and setting. Methods RCT data over 16 months from English care-home residents with dementia (intervention n = 418; control n = 308) were analysed. We conducted a cost-utility analysis from the healthcare provider perspective. We gathered resource use and utility (EQ-5D-5L and DEMQoL-Proxy-U) from people living with dementia and proxy informants (staff and relatives). Data were analysed using seemingly unrelated regression, accounting for care-home clustering and bootstrapping used to capture sampling uncertainty. Results Costs were higher in the intervention arm than in the control arm (incremental = £1479) due in part to high cost outliers. There were small QALY gains (incremental = 0.024) in favour of DCM. The base-case ICER (£64,380 per QALY) suggests DCM is not cost-effective versus usual care. With the exception of analyses excluding high cost outliers, which suggested a potential for DCM to be cost-effective, sensitivity analyses corroborated the base-case findings. Bootstrapped estimates suggested DCM had a low probability (< 0.20 where λ = £20,000) of being cost-effective versus control. Conclusion DCM does not appear to be a cost-effective intervention versus usual care in this group and setting. The evaluation highlighted several methodological challenges relating to validity of utility assessments, loss to follow-up and compliance. Further research is needed on handling high-cost individuals and capturing utility in this group. ISRCTN reference 82288852.Dementia Care Mapping is not cost-effective versus usual care in preventing or supporting agitation in carehome residents with dementia.The trial highlighted a number of challenges to the economic evaluation that future studies should consider at design stage including dealing with: low intervention compliance; high levels of missing data; uncertain validity of utility assessments in this population; and high cost outliers.

Effectiveness of Dementia Care Mapping™ to reduce agitation in care home residents with dementia: an open-cohort cluster randomised controlled trial

“…The cost per unit improvement in CMAI was higher than other recent evaluations of interventions involving staff training in PCC or communication skills with or without behavioural management training (£6 to £62, 2011 UK prices) (Livingston, Barber, et al, 2014). The cost per QALY was also higher than the upper bound of the threshold over which treatments are least likely to be funded in England, although some lower estimates were reported in sensitivity analyses (Meads et al, 2020). The findings align with one (Chenoweth et al, 2009) and contrast with another previous, non-UK, cost analysis of DCM (van de Ven et al, 2014).…”

“…This is reported in detail elsewhere (Meads et al, 2020). In summary, the total cost of DCM was estimated to be £421.07 per resident (£9,290.30 per care home).…”

“…This pragmatic, multi-centre, cluster RCT recruited residential and nursing homes providing care to people living with dementia. It included an integral (published separately) cost-effectiveness analysis (Meads et al, 2020) and process evaluation (Griffiths, Kelley, et al, 2019;Surr, Shoesmith, et al, 2019). Follow up was at 6 and 16 months.…”

Dementia Care Mapping™ to reduce agitation in care home residents with dementia: the EPIC cluster RCT

“…157 © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.…”

Economics of Mental Health: Providing a Platform for Efficient Mental Health Policy

“…Several articles focused on efforts to improve mental health care for vulnerable populations [15][16][17][18]. Cullinan et al examined socioeconomic disparities in unmet need for student mental health services in higher education in Ireland [15].…”