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

Author

Listed:
  • David M. Meads

    (University of Leeds)

  • Adam Martin

    (University of Leeds)

  • Alys Griffiths

    (Leeds Beckett University)

  • Rachael Kelley

    (Leeds Beckett University)

  • Byron Creese

    (University of Exeter)

  • Louise Robinson

    (Newcastle University)

  • Joanne McDermid

    (King’s College London)

  • Rebecca Walwyn

    (University of Leeds)

  • Clive Ballard

    (University of Exeter)

  • Claire A. Surr

    (Leeds Beckett University)

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 (

Suggested Citation

  • David M. Meads & Adam Martin & Alys Griffiths & Rachael Kelley & Byron Creese & Louise Robinson & Joanne McDermid & Rebecca Walwyn & Clive Ballard & Claire A. Surr, 2020. "Cost-Effectiveness of Dementia Care Mapping in Care-Home Settings: Evaluation of a Randomised Controlled Trial," Applied Health Economics and Health Policy, Springer, vol. 18(2), pages 237-247, April.
    • Handle: RePEc:spr:aphecp:v:18:y:2020:i:2:d:10.1007_s40258-019-00531-1
    DOI: 10.1007/s40258-019-00531-1
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    References listed on IDEAS

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    1. Elisabeth Fenwick & Karl Claxton & Mark Sculpher, 2001. "Representing uncertainty: the role of cost‐effectiveness acceptability curves," Health Economics, John Wiley & Sons, Ltd., vol. 10(8), pages 779-787, December.
    2. Rita Faria & Manuel Gomes & David Epstein & Ian White, 2014. "A Guide to Handling Missing Data in Cost-Effectiveness Analysis Conducted Within Randomised Controlled Trials," PharmacoEconomics, Springer, vol. 32(12), pages 1157-1170, December.
    3. Geertje van de Ven & Irena Draskovic & Elke van Herpen & Raymond T C M Koopmans & Rogier Donders & Sytse U Zuidema & Eddy M M Adang & Myrra J F J Vernooij-Dassen, 2014. "The Economics of Dementia-Care Mapping in Nursing Homes: A Cluster-Randomised Controlled Trial," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-8, January.
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