Cost-effectiveness of one year dementia follow-up care by memory clinics or general practitioners: economic evaluation of a randomised controlled trial

Abstract

Objective: To evaluate the cost-effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared to general practitioners' care.

Methods: A multicentre randomised trial with 175 community dwelling patients newly diagnosed with mild to moderate dementia, and their informal caregivers, with twelve months' follow-up. Cost-effectiveness was evaluated from a societal point of view and presented as incremental cost per quality adjusted life year. To establish cost-effectiveness, a cost-utility analysis was conducted using utilities based on the EQ-5D. Uncertainty surrounding the incremental cost-effectiveness ratio (difference in costs divided by difference in effects) was calculated by bootstrapping from the original data.

Results: Compared to general practitioners' care, treatment by the memory clinics was on average €1024 (95% CI: -€7723 to €5674) cheaper, and showed a non-significant decrease of 0.025 (95% CI: -0.114 to 0.064) quality adjusted life years. The incremental cost-effectiveness point estimate from the bootstrap simulation was € 41 442 per QALY lost if one would use memory clinic care instead of general practitioner care.

Conclusion: No evidence was found that memory clinics were more cost-effective compared to general practitioners with regard to post-diagnosis treatment and coordination of care of patients with dementia in the first year after diagnosis.

Trial registration: ClinicalTrials.gov NCT00554047.

Figure 1. Scatterplot of the estimated incremental costs and incremental effects obtained by bootstrap simulations.

Figure 2. Cost-effectiveness acceptability curve.

The probability that the Memory Clinic was cost-effective compared with the General Practitioner (solid line). The dotted line shows the curve if only the QALY of the patient as rated by the caregiver was used. The striped and the stripe-dot line show the probability if the cost and QALY of the patient alone and if the cost and QALY of the caregiver alone (cost of the caregiver being caregiving time and productivity loss) were used respectively.