The Cost‐Effectiveness of an Intervention to Preserve Independence in People With Dementia (Vs. No Intervention): A Decision‐Analytic (Markov) Model Analysis

TL;DR

The study finds that interventions helping people with dementia stay independent in daily tasks can be cost-effective if they reduce the need for higher care levels.

Contribution

This study provides a novel cost-effectiveness analysis of hypothetical interventions aimed at preserving independence in people with dementia.

Findings

An intervention costing £570/person can be cost-effective if it reduces dependence by 7.5%.

Lower-cost interventions (£250/person) require smaller effects (2.5%) to be cost-effective.

Including informal care costs increases the required intervention effect for cost-effectiveness.

Abstract

Interventions that enable people with dementia to retain some independence in activities of daily living (ADL) may delay transitions into residential care and offset sharp reductions in quality of life (QoL). The aim of this study was to estimate how effective a hypothetical intervention needs to be at preserving independence in home‐dwelling people with dementia, to be cost‐effective.

A decision‐analytic model was constructed to compare costs and outcomes of a cohort of people with dementia in the United Kingdom and European Union over a 10‐year period. At model entry, the cohort was distributed across low, moderate, or high levels of dependence. The impact of a hypothetical intervention that preserves independence was evaluated by reducing the proportion of people entering the model with moderate and high dependence. The model included costs for the intervention and health and social care resource use. Secondary analysis included estimated costs of informal care. Health benefit was measured as quality‐adjusted life‐years (QALYs).

The cost of the intervention was £570/person. At this cost, an intervention that resulted in 7.5% of the sample entering the model in a lower level of dependence (compared with no intervention) was likely to be cost‐effective (£8690/QALY). An intervention costing £250/person would only need a 2.5% effect and one costing £1000/person would need to have a 10% effect to be potentially cost‐effective. Including informal care costs increased the size of the effect required for the intervention to be cost‐effective because more of the care provided at lower levels of dependence is informal.

Preserving independence in people with dementia may be a cost‐effective way to help them live well for longer. Our results provide a guide on costs and required effects for those developing interventions to preserve independence in people with dementia.

Despite recent developments, dementia currently remains without a cure, more research is needed to help people live well with dementia.Helping people with dementia to retain independence in activities of daily living may improve their quality of life, but there is limited evidence on the cost‐effectiveness of doing so.Our analysis suggests that interventions which help people with dementia retain some independence in activities of daily living may be cost‐effective.High‐quality evaluations of independence‐preserving interventions are needed to drive a change in evidence‐based practice.

Despite recent developments, dementia currently remains without a cure, more research is needed to help people live well with dementia.

Helping people with dementia to retain independence in activities of daily living may improve their quality of life, but there is limited evidence on the cost‐effectiveness of doing so.

Our analysis suggests that interventions which help people with dementia retain some independence in activities of daily living may be cost‐effective.

High‐quality evaluations of independence‐preserving interventions are needed to drive a change in evidence‐based practice.

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