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

Abstract

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.

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

“…Our short‐term cost‐effectiveness analysis reported that patients attending MAS had a QALY gain according to DEMQOL‐U of 0.021 and EQ‐5D‐3 L of 0.023 over the first 6 months after referral. This study shows that the improvement in HRQL is maintained to 2 years, although the EQ‐5D‐3 L gain is smaller (0.014) than at 6 months (0.023).…”

“…Thirdly, this economic evaluation is based on rigourous collection of data on different measures of effectiveness (both disease‐specific and generic HQRL measures), and costs to the NHS, social care, carers, and patients (societal perspective). Fourthly, our cost‐effectiveness findings are based on longitudinal measurements of both costs and outcomes over 2 years, and hence, captures the impact of MAS over a longer period than previous studies based on a single time point and short follow up: either 3 months, 6 months, or 1 year …”

“…Full details on the sampling, recruitment, and data collection methods are reported elsewhere . Briefly, the study included 69 MAS, a random sample from the 212 clinics identified by the Royal College of Psychiatrists' National Audit.…”

“…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.…”

“…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.…”