. 2019 Jun;3(2):215-227.

doi: 10.1007/s41669-018-0097-9.

Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial

Iftekhar Khan^{1

2}, Stavros Petrou³, Kamran Khan³, Dipesh Mistry³, Ranjit Lall³, Bart Sheehan⁴, Sarah Lamb^{3

5

6}; DAPA Trial Group

Collaborators, Affiliations

Collaborators

DAPA Trial Group:
Sarah Lamb, Bart Sheehan, Dipesh Mistry, Ranjit Lall, Iftekhar Khan, Kamran Khan, Stavros Petrou, Sukhdeep Dosanjh, Sharisse Alleyne, Susie Hennings, Vivien Nichols, S Finnegan, Nicky Atherton, Debbie Brown, Helen Collins, Brian Lawlor, Angela Clayton Turner, Jenny Freeman, Sarah Lamb, Paul McCrone, Bart Sheehan, Roy Jones, Julian Hughes, Patrick Phillips, Dipesh Mistry, N Atherton, S Bridgewater, E Eyre, S Finnegan, L Hall, L Hill, P Hall, H Johnson, G Kaur, L Langdon, J Lowe, S Mathews, J Millichap, J Nussbaum, I On-Kar, C Ritchie, V Russell, G Scott, S Shore, A Slowther, K Spanjers, L Stonehewer, M Thorogood, J Todd, A Ullah, H Waters, L Woods, E Withers, P Zeh, A Bond, D Brown, C Byrne, R McShane, H Richmond, N Thomas, J Thompson, C Dransfield, F Le Frenais, C Hall, O Rye, R Carson, M Clarke, H Eaton, H Ellis, A Farrand, S Gardner, C Harducas, L Rigby, J Wilson, L Hill, L Johnson, L Lord, L Johnson, T Qassam, S Sadier, A Shipman, L South, J Statham, J Tomkins, D Weaver, B Coope, D Craddock, A Johal, J Lee, J Lindsay, J Tucker, R Vanderputt, V Cross, G Glithens-Mather, L Martin, C O'Reilly, E Rogers, R Sheridan, K Birtwell, J Brooke, A Davis, C Hinze, S Hussain, A Kennedy, H Mistry, R Noble, R Norton, E Oughton, V Sherwin, P Tinker, D Glancey, H Karrin, M Marudkar, G Borley, T Crisp, P Koranteng, A Lovesy, S Vogel, B Browne, L Colbourn, A Feast, E Hanratty, R Legerd, R Niland-Smith, Theresa Sullivan, Tony Sullivan, A Streater, H St Roas, M Anderton, R Blake, K Brown, S Marriott, S Simpson, A Thornhill, L Colbourn, F Dawe, T Kuruvilla, L Moore, R Niland-Smith, M Phillips, G Riley, A Uthup

Affiliations

¹ Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK. i.khan.2@warwick.ac.uk.
² King's College London, University of London, London, UK. i.khan.2@warwick.ac.uk.
³ Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
⁴ Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁵ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
⁶ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research In Oxford, University of Oxford, Oxford, UK.

PMID: 30206826
PMCID: PMC6533370
DOI: 10.1007/s41669-018-0097-9

Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial

Iftekhar Khan et al. Pharmacoecon Open. 2019 Jun.

. 2019 Jun;3(2):215-227.

doi: 10.1007/s41669-018-0097-9.

Authors

Iftekhar Khan^{1

2}, Stavros Petrou³, Kamran Khan³, Dipesh Mistry³, Ranjit Lall³, Bart Sheehan⁴, Sarah Lamb^{3

5

6}; DAPA Trial Group

Collaborators

DAPA Trial Group:
Sarah Lamb, Bart Sheehan, Dipesh Mistry, Ranjit Lall, Iftekhar Khan, Kamran Khan, Stavros Petrou, Sukhdeep Dosanjh, Sharisse Alleyne, Susie Hennings, Vivien Nichols, S Finnegan, Nicky Atherton, Debbie Brown, Helen Collins, Brian Lawlor, Angela Clayton Turner, Jenny Freeman, Sarah Lamb, Paul McCrone, Bart Sheehan, Roy Jones, Julian Hughes, Patrick Phillips, Dipesh Mistry, N Atherton, S Bridgewater, E Eyre, S Finnegan, L Hall, L Hill, P Hall, H Johnson, G Kaur, L Langdon, J Lowe, S Mathews, J Millichap, J Nussbaum, I On-Kar, C Ritchie, V Russell, G Scott, S Shore, A Slowther, K Spanjers, L Stonehewer, M Thorogood, J Todd, A Ullah, H Waters, L Woods, E Withers, P Zeh, A Bond, D Brown, C Byrne, R McShane, H Richmond, N Thomas, J Thompson, C Dransfield, F Le Frenais, C Hall, O Rye, R Carson, M Clarke, H Eaton, H Ellis, A Farrand, S Gardner, C Harducas, L Rigby, J Wilson, L Hill, L Johnson, L Lord, L Johnson, T Qassam, S Sadier, A Shipman, L South, J Statham, J Tomkins, D Weaver, B Coope, D Craddock, A Johal, J Lee, J Lindsay, J Tucker, R Vanderputt, V Cross, G Glithens-Mather, L Martin, C O'Reilly, E Rogers, R Sheridan, K Birtwell, J Brooke, A Davis, C Hinze, S Hussain, A Kennedy, H Mistry, R Noble, R Norton, E Oughton, V Sherwin, P Tinker, D Glancey, H Karrin, M Marudkar, G Borley, T Crisp, P Koranteng, A Lovesy, S Vogel, B Browne, L Colbourn, A Feast, E Hanratty, R Legerd, R Niland-Smith, Theresa Sullivan, Tony Sullivan, A Streater, H St Roas, M Anderton, R Blake, K Brown, S Marriott, S Simpson, A Thornhill, L Colbourn, F Dawe, T Kuruvilla, L Moore, R Niland-Smith, M Phillips, G Riley, A Uthup

Affiliations

¹ Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK. i.khan.2@warwick.ac.uk.
² King's College London, University of London, London, UK. i.khan.2@warwick.ac.uk.
³ Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
⁴ Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁵ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
⁶ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research In Oxford, University of Oxford, Oxford, UK.

PMID: 30206826
PMCID: PMC6533370
DOI: 10.1007/s41669-018-0097-9

Abstract

Background: Previous studies suggest that physical exercise could slow dementia progression. However, evidence for the cost effectiveness of structured exercise is conflicting and based on small trials.

Objectives: The objective of this study was to compare the cost effectiveness of a tailored, structured, moderate- to high-intensity exercise programme versus usual care in people with mild to moderate dementia.

Methods: An economic evaluation was conducted from the UK National Health Service and personal social services perspective, based on data from a large randomised controlled trial. The primary clinical outcome was the participant reported ADAS-Cog (Alzheimer's Disease Assessment Scale-Cognitive Subscale) at 12 months. Costs (£; 2014-2015 prices) were collected prospectively over a 12-month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted with the view to estimating the incremental cost per QALY gained and the incremental net monetary benefit (INMB) associated with the exercise programme plus usual care versus usual care. Sensitivity analyses were undertaken to assess the impact of uncertainty surrounding aspects of the economic evaluation, and pre-specified subgroup analyses explored heterogeneity in the cost-effectiveness results.

Results: Participants (n = 494) were randomised to exercise plus usual care or usual care only. By 12 months the mean ADAS-Cog score had worsened slightly to 25.2 (standard deviation [SD] 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care: difference - 1.4, 95% confidence interval (CI) - 2.6 to - 0.2 (p = 0.03). The mean (standard error [SE]) costs over 12 months for experimental versus control was £5945 (US$7856) versus £4597 (US$6574), respectively; (difference: £1347 [$1926]; p = 0.0426). Mean (SE) QALY estimates were 0.787 (0.012) versus 0.826 (0.019), respectively (p = 0.090). The probability that the exercise programme is cost effective was < 1% across cost-effectiveness thresholds. INMBs ranged between -£2601 (US$3719) and £2158 (US$3086) at cost-effectiveness thresholds between £15,000 (US$21,450) and £30,000 (US$42,900) per QALY. The cost-effectiveness results remained robust to several sensitivity and subgroup analyses.

Conclusions: Building on the clinical results of the trial, which showed that the structured exercise programme evaluated does not slow cognitive impairment in people with mild to moderate dementia, this economic evaluation shows that the programme is not cost effective.

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Conflict of interest statement

Dr Iftekhar Khan, Prof. Stavros Petrou, Mr Kamran Khan, Dr Dipesh Mistry, Dr Ranjit Lall, Dr Bart Sheehan and Prof. Sarah Lamb declare no conflicts of interest related to this study.

Figures

**Fig. 1**
Cost-effectiveness plane. *GBP* British pounds, *QALYs* quality-adjusted life-years

**Fig. 2**
Cost-effectiveness acceptability curve. *GBP* British pounds

**Fig. 3**
Sensitivity and subgroup analyses. CE cost effectiveness, CI confidence interval, *INMB* incremental net monetary benefit, *LCL* lower 95% confidence interval, *MMSE* Mini-Mental State Examination, *QALY* quality-adjusted life-year, *UCL* upper 95% confidence interval

See this image and copyright information in PMC

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Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial

Collaborators

Affiliations

Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources

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