Costs and cost‐effectiveness of the meeting centres support programme for people living with dementia and carers in Italy, Poland and the UK: The MEETINGDEM study

Abstract

We examined the costs and cost-effectiveness of the Meeting Centre Support Programme (MCSP) implemented and piloted in the UK, Poland and Italy, replicating the Dutch Meeting Centre model. Dutch Meeting Centres combine day services for people with dementia with carer support. Data were collected over 2015-2016 from MCSP and usual care (UC) participants (people with dementia-carer dyads) at baseline and 6 months. We examined participants' health and social care (HSC), and societal costs, including Meeting Centre (MC) attendances. Costs and outcomes in MCSP and UC groups were compared. Primary outcomes: Persons with dementia: qualityadjusted life years (EQ-5D-5L-derived); QOL-AD. DQoL was examined as a secondary outcome. Carers: Short Sense of Competence Questionnaire (SSCQ). Incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves were obtained by bootstrapping outcome and cost regression estimates. Eighty-three MCSP and 69 UC dyads were analysed. The 6-month cost of providing MCSP was €4,703; participants with dementia attended MC a mean of 45 times and carers 15 times. Including intervention costs, adjusted 6-month HSC costs were €5,941higherin MCSP than in UC. From the HSC perspective: in terms of QALY, the probability of cost-effectiveness was zero over willingness-to-pay (WTP) ranging from €0 to €350,000. On QOL-AD, the probability of cost-effectiveness of MCSP was 50% at WTP of €5,000 for a one-point increase. A one-point gain in the DQoL positive affect subscale had a probability of cost-effectiveness of 99% at WTP over €8,000.On SSCQ, no significant difference was found between MCSP and UC. Evidence for cost-effectiveness of MCSP was mixed but suggests that it may be cost-effective in relation to gains in dementia-specific quality of life measures. MCs offer effective tailored post-diagnostic support services to both people with dementia and carers in a | 1757 HENDERSON Et al.

Further development needed: models of post-diagnostic support for people with dementia

“…Meeting Centres originated in the Netherlands. Recent evaluation of Meeting Centres in Italy, Poland and the UK showed positive impacts on person with dementia and carer outcomes [25 ▪ ,26] though not consistently [27 ▪ ]; however, the cost-effectiveness evaluation was inconclusive [28 ▪ ]. Meeting centres have led to country-specific changes (positive and negative) in different aspects of stigma [29 ▪▪ ]; these may be due to the active contribution of people with dementia and carers to centre programs [30 ▪ ].…”

Effectiveness of community non-pharmacological interventions for mild cognitive impairment and dementia: a systematic review of economic evaluations and a review of reviews

“…The majority of studies were randomised controlled trials (n=26), followed by nonrandomised studies (n=5) and one modelling study. Study sample size varied greatly, ranging from 50 to 3269. International reach of the studies was the UK (n=13) (7,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), Germany (n=4) (30)(31)(32)(33), Finland (n=3) (34)(35)(36) and Netherlands (n=3) (37)(38)(39), United States (n=2) (40,41)and Denmark (n=2) (42,43), Australia (n=1) (44), Japan (n=1) (45), Canada (n=1) (46), Singapore (n=1 (47) and there was a multi-national study involving Italy, Poland and the UK (48).…”

“…Henderson et al conducted a non-randomised study to evaluate meeting centres providing day support using CUA (48). The study had a short time horizon at six months and was not cost-effective in terms of QALYs.…”

“…Three of the six multi-disciplinary studies took place in the same country, which may lead to a geographical bias (31)(32)(33). It should also be noted that only one of the multidisciplinary studies assessed UK based services (48).…”

Dementia and COVID-19 in Chile, New Zealand and Germany: A Research Agenda for Cross-Country Learning for Resilience in Health Care Systems

“…The challenges of using a comparative approach and the potential for learning are well recognized [34], and examples can be found in previous trilateral health care studies: comparing access to HIV diagnosis for indigenous populations in Canada, Australia and New Zealand [120]; palliative care strategies in advanced dementia in Israel, the US and the Netherlands [121]; and the cost-effectiveness of dementia support structures in three European countries [122]. However, multi-lateral studies in the context of health care systems and dementia often remain at a largely descriptive level, with less focus on understanding the reasons for system development and the potential for learning from each other [34].…”