What are the current and projected future cost and health‐related quality of life implications of scaling up cognitive stimulation therapy?

Abstract

Objectives: Cognitive stimulation therapy (CST) is one of the few nonpharmacological interventions for people living with dementia shown to be effective and cost-effective. What are the current and future cost and health-related quality of life implications of scaling-up CST to eligible new cases of dementia in England? Methods/design: Data from trials were combined with microsimulation and macrosimulation modelling to project future prevalence, needs and costs. Health and social costs, unpaid care costs and quality-adjusted life years (QALYs) were compared with and without scaling-up of CST and follow-on maintenance CST (MCST).Results: Scaling-up group CST requires year-on-year increases in expenditure (mainly on staff), but these would be partially offset by reductions in health and care costs. Unpaid care costs would increase. Scaling-up MCST would also require additional expenditure, but without generating savings elsewhere. There would be improvements in general cognitive functioning and health-related quality of life, summarised in terms of QALY gains. Cost per QALY for CST alone would increase from £12,596 in 2015 to £19,573 by 2040, which is below the threshold for costeffectiveness used by the National Institute for Health and Care Excellence (NICE).Cost per QALY for CST and MCST combined would grow from £19,883 in 2015 to £30,906 by 2040, making it less likely to be recommended by NICE on costeffectiveness grounds.Conclusions: Scaling-up CST England for people with incident dementia can improve lives in an affordable, cost-effective manner. Adding MCST also improves healthrelated quality of life, but the economic evidence is less compelling.

Scaling‐up an evidence‐based intervention for family carers of people with dementia: Current and future costs and outcomes

“…Scaling‐up START in this way would cost around £11.6 million in 2025, for example, with total annual health and social care service savings of £60.8 million, making it not only effective and cost‐effective, but also cost‐saving. (This contrasts with a similar analysis for cognitive stimulation therapy that we conducted recently which found significant outcome gains but no cost savings 31 19 …”

“…(This contrasts with a similar analysis for cognitive stimulation therapy that we conducted recently which found significant outcome gains but no cost savings. 31 ) Savings would be generated in both the health and social care systems, including reductions in GP appointments, inpatient hospital stays, social worker and community worker contacts, and day care attendances. 19 Providing START across England would require investments that increased annually given the expected rise in the number of people with dementia.…”

Digital interventions for people with dementia and carers: effective, cost-effective and equitable?

“…There are other challenges, such as geographical barriers and mobility issues that constrain access to in-person services. Thus, even though scaling up of existing evidence-based interventions such as cognitive stimulation therapy is in theory an affordable, cost-effective way to improve lives of people with dementia [ 3 ], accessing these interventions will likely be hugely difficult.…”

Group cognitive stimulation therapy versus usual care for people with intellectual disabilities and dementia (CST-IDD) in the UK: protocol for a mixed-methods feasibility randomised controlled trial

“… 3 In the UK National Institute for Health and Care Excellence guidelines, 4 group CST is the only non-pharmacological post-diagnostic intervention specifically recommended to support cognition, independence and well-being in individuals with dementia. CST has been shown to be cost-effective 5 and has comparable cognitive benefits to anti-dementia medication 6 in the general dementia population. CST is delivered in a group, typically as two 45-min sessions a week, for 7 weeks.…”